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RC201  .C542  1 921     The  control  of  sex  i 


ColuntWa  ®ntt)er^itp 

College  of  ^f^v^itian^  anb  ^urgeong 


THE  CONTROL 
OF  SEX  INFECTIONS 


THE  MACMILLAN  COMPANY 

NEW  YORK        BOSTON  •    CHICAGO  •    DALLAS 
ATLANTA   •    SAN   FRANCISCO 

MACMILLAN  &  CO.,  Limited 

LONDON  •  BOMBAY  •  CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Ltd. 

TORONTO 


THE  CONTROL,/^  ^^ 
OF  SEX  INFECTIONS 


BY 

J.  BAYARD  CLARK,  M.D. 

Fellow  of  the  New  York  Academy  of  Medicine;  Fellow 

of  the  American  College  of  Surgeons;  Member  of 

American  Urological  Association;  American 

Association  Genito  Urinary  Surgeons; 

International  Surgical  Society; 

Sometime  Major  Medical 

Corps  U.  S.  Army,  etc. 


I13eto  gotb 

THE  MACMILLAN  COMPANY 
1921 

All  rights  reserved 


rj  /^' 


/  a^ 


COPYEIGHT,    1921, 

By  the  MACMILLAN  COMPANY 


Set  up  and  electrotyped.     Published,  January,  1921 


PREFACE 

If  this  small  book  serves  to  set  in  mo- 
tion a  little  more  general  thinking  in  this 
vast  domain  of  human  interest,  it  will  have 
accomplished  something.  It  is  hoped  that 
it  will  do  more,  by  helping  somewhat  to 
lift  the  subject  up  from  the  back  recesses 
of  the  mind  and  bring  it  forward  into  the 
daylight  of  open  and  purposeful  discus- 
sion. 

With  due  recognition  of  the  motives 
which  in  bygone  days  prompted  teachers 
and  parents  to  sustain  a  state  of  ignorance 
on  sexual  affairs,  I  have  attempted  to 
make  clear  the  fallacy  of  this  old,  and  what 
we  now  know  to  be,  costly  custom.  We 
have  long  been  in  possession  of  sufficient 
knowledge  of  the  child  mind  and  its  devel- 
opment to  be  able  to  supply  it  with  in- 
formative matter,  at  such  time  and  in  such 
measure  as  to  help  rather  than  hinder  the 
child's  mental  and  moral  growth. 


vi  PREFACE 

If  I  have  criticised  society  somewhat 
severely  for  its  past  attitude  toward  the 
sexual  disease  problem,  I  trust  that  it  will 
be  taken  as  constructive  rather  than  de- 
structive criticism. 

If  I  have  seemed  unduly  critical  of  the 
medical  profession's  part  in  this  large 
human  concern  I  should  hke  to  state  that 
I  have  the  fullest  confidence  in  that  profes- 
sion's responsiveness  to  any  real  public 
endeavor  which  is  sincerely  aimed  at  the 
overthrow  of  this  social  menace. 

Society  has  so  long  disliked  to  have  the 
comfort  of  its  mind  or  mode  of  life  dis- 
turbed that  any  contest  with  these  dis- 
eases, which  is  scientifically  rational,  may, 
I  fear,  appear  sorely  radical.  That  which 
is  simply  direct  may  seem  severely  dog- 
matic. I  believe,  however,  that  if  we  would 
not  strip  off  altogether  the  veil  of  sanctity 
with  which  we  instinctively  surround  sex 
and  its  ennobling  part  played  in  the  normal 
union  of  man  and  woman,  it  is  high  time 
this  subject  of  the  sexual  diseases  was  met 
as  it  becomes  brave  men  and  women  to 
meet  a  mortal  enemy. 


PREFACE  vii 

It  is  impossible  to  pass  on  without  draw- 
ing due  attention  to  the  brilliant  pioneer 
work  of  August  Forel,  Havelock  Ellis  and 
Prince  A.  Morrow  in  this  particular  field 
of  social  medicine.  In  the  present  after- 
war  flare  of  attention  to  this  subject  it  is 
to  the  vision  of  such  men  that  much  of  our 
structural  effort  today  owes  its  ground 
work. 

Though  I  remain  acutely  conscious  of 
the  many  shortcomings  of  this  small  vol- 
ume, I  still  trust  that  it  may  prove  to  be  in 
some  degree  suggestive. 

J.  B.  C. 


CONTENTS 

CHAPTER  PAGE 

I    Inteoduction 1 

II    Underlying  Causes  of  Sexual  Diseases  10 

III    What  the  War  Has  Revealed    ...  22 

IV    The  Role  op  Alcohol  in  the  Sexual 

Infections  and  Fecundation  ...  39 

V    The  Prevention  of  Sexual  Infections  44 

VI    What  Every  Boy  and  Girl  Should  Be 

Taught 61 

VII    The  Importance  of  Universal  Train- 
ing TO  Sexual  Health 77 

VIII    Systematic  Care  of  the  Sexual  Infec- 
tions        98 

IX    Man's  Obligation  to  Society    .     .     .  125 


THE  CONTROL  OF  SEX 
INFECTIONS 

CHAPTEE  I 
INTRODUCTION 

It  may  be  stated  here,  that  the  subject 
matter  of  this  book  was  not  selected  be- 
cause it  is  a  pleasing  topic  to  deal  with; 
neither  was  it  chosen  because  it  is  a  re- 
proach to  those  who  are  mainly  responsible 
for  these  disastrous  diseases  which  we  could 
get  along  so  very  well  without;  nor  has  it 
been  picked  out  because  of  the  world's  per- 
fectly obvious  neglect  of  this  whole  sub- 
ject ;  but  it  was  chosen  because  it  is  the  firm 
belief  of  many  well  informed  students  that 
to-day,  with  the  general  interest  and  the 
sincere  and  active  cooperation  of  the  medi- 
cal profession  with  society  at  large,  very 
much  may  be  done  toward  the  elimination 
of  these  truly  terrible  and  insidious  dis- 


2  CONTROL  OF  SEX  INFECTIONS 

eases.  It  is  for  this  reason  that  the  author 
offers  this  small  contribution  to  the  cause. 

In  the  rush  of  reconstruction  we  see  the 
mask  stripped  from  the  motives  of  men; 
here  sincerity  shines,  there  selfishness  and 
greed  gain  ground.  Human  nature  has  not 
changed,  it  has  merely  been  exposed;  yet 
it  is  only  now,  before  the  mortar  of  a  new 
peace  period  has  set,  that  the  corner-stone 
of  any  new  conduct  can  be  laid. 

So  much,  then,  of  generalities  from  which 
each  one  must  descend  to  his  own  sphere 
of  labor,  if  the  task  ahead  is  not  to  be  neg- 
lected. The  sphere  of  the  doctor's  work 
like  that  of  many  others  has  been  deeply 
changed  by  the  war.  With  the  doctor  it 
has  been  an  encouraging  change.  Up  to 
the  war  he  had  been  shrinking  more  and 
more  into  a  technical  and  conventional  rut 
along  which  he  pursued  his  way.  The  war 
has  shaken  him  out  onto  the  surface  of  the 
earth  again.  He  becomes  once  more  a  citi- 
zen. He  has  human  interests  as  well  as 
scientific.  He  thinks  more  of  the  work  of 
the  State  and  its  obligations ;  of  sanitation 
and  the  general  prevention  of  sickness  and 


INTRODUCTION  3 

injury.  He  even  thinks  of  the  physical  and 
moral  development  of  his  fellow-man  and 
the  environment  which  will  best  bring  these 
things  about.  In  this  new  role  then  of  cit- 
izen as  well  as  scientist  the  world  must 
needs  look  to  the  medical  man  for  the  suc- 
cess of  its  sanitation  and  its  protection 
against  preventable  ills.  It  is  here  that  we 
may  well  narrow  our  discussion  to  the  sub- 
ject matter  of  this  book, — that  of  the  sexual 
diseases,  which  in  themselves  represent  so 
large  a  part  of  the  world's  preventable  ill- 
ness, which  even  represent  no  inconsider- 
able part  of  the  world's  preventable  death- 
roll — both  in  utero  and  out  of  it.  And  yet 
(and  this  is  what  adds  a  peculiar  interest 
to  the  matter  in  hand),  here  is  a  subject 
which  polite  society  has  seemingly  not 
cared  to  meet  face  on.  In  fact,  up  to  the 
period  of  the  war  this  whole  subject  of  sex- 
ual sickness  has  had  in  the  English-speak- 
ing parts  of  the  world  a  most  singular  ca- 
reer. As  unmolested  monarchs  have  these 
easily  preventable  infections  marched  into 
the  innermost  circles  of  society,  without 
even  arousing  academic  discussion  as  to 


4  CONTROL  OF  SEX  INFECTIONS 

their  elimination — easy  conquerors  of  an 
easy  people. 

Can  it  be  that  society  feels  that  the 
medical  profession  has  done  all  there  is  to 
be  done  to  forestall  this  festering  and 
flourishing  march?  In  that  case  the  sub- 
ject is  really  an  interesting  one.  Has  so- 
ciety itself  qualms  as  to  the  disgraceful  side 
of  these  sicknesses?  Certainly  the  pitfalls 
ahead  of  the  young  have  been  strangely 
well  shielded  from  sight,  and  the  whole  sub- 
ject of  sex  secluded  by  secrecy  and  sham, 
much  as  if  one  generation  had  something 
very  like  personal  reasons  for  keeping  the 
next  generation  in  the  dark.  So  unmen- 
tionable indeed  has  this  matter  been  in  con- 
ventional circles  that  even  the  medical  man 
with  social  aims  of  his  own, — for  many  a 
good  man  steps  down  in  the  world  when  he 
thinks  he  is  stepping  up, — would  carefully 
sink  his  professional  activities  with  sex- 
ually diseased  patients  and  throw  up  his 
hands  in  horror,  much  the  same  as  anyone 
else,  when  the  danger-line  of  this  topic  was 
neared.  Thus  has  the  future  of  our  human 
family  been  dealt  with. 


INTRODUCTION  5 

Is  it  possible  that  our  fashionable  charity 
hospitals  whose  doors  have  been  closed  to 
these  cases  share  any  of  the  blame  for  the 
devastating  tragedies  of  these  diseases? 
All  these  are  matters  of  no  small  impor- 
tance at  this  time  of  social  reconstruction. 
And  our  ministers,  and  teachers  of  the 
young; — what  has  been  their  activity  in 
this  vital  issue  of  sexual  health  and  in- 
tegrity while  they  have  been  moulding  the 
minds  and  characters  of  the  future  mothers 
and  fathers  of  our  race?  Very  suggestive 
are  these  hints  as  to  why  we  suffer  from 
such  a  prevalence  of  these  pestilent  dis- 
eases, but  in  the  following  chapters  an 
effort  will  be  made  to  centre  the  responsi- 
bility more  exactly. 

Who  would  not  be  in  sympathy  with  the 
general  distaste  of  this  whole  vice-ladened 
subject  of  the  sexual  sicknesses!  Cer- 
tainly only  those  with  vice-ladened  minds. 
But  does  that  free  society  from  its  obliga- 
tions? Let  us  hope  otherwise.  One  ap- 
preciates without  effort  how  much  pleas- 
anter  it  is  even  for  the  medical  profession 
to  exclude  as  much  as  possible  the  thought 


6  CONTROL  OF  SEX  INFECTIONS 

and  suggestion  of  these  ills  from  any 
branch  of  medicine.  Even  in  urology  it  is 
pleasanter  to  follow  in  our  practice  the 
course  of,  for  example,  the  surgical  devel- 
opment in  that  branch,  rather  than  to  think 
and  work^  or  call  attention  to  the  fact  that 
we  work  in  terms  of  diplococci  or  wriggling 
spirochetes.  But  can  we  be  so  easily  re- 
lieved of  that  which  is  disagreeable  I  Our 
recent  war  experience  inclines  us  to  think 
not. 

In  that  branch  of  medicine  dealing  mth 
the  diseases  of  women — it  is  not  only 
easier,  but  infinitely  more  profitable,  to 
wait  until,  let  us  say,  a  gonococcus  infec- 
tion has  developed  into  a  pelvic  pus  sac 
destroying  motherhood  and  health  for  the 
woman,  also  providing  a  surgical  opera- 
tion, than  it  is  to  turn  our  first  and  best 
energy  into  work  preventive  of  these  con- 
ditions. What  a  field  indeed  of  medical 
prevention  and  endeavor  the  gynecologist 
— the  specialist  in  disease  of  women — and 
the  general  surgeon  too  for  that  matter, 
has  left  open — and  left  behind  him,  while 
he  mined  gold  dust  from  the  gonococcus. 


INTRODUCTION  7 

In  France  the  peasants  seem  perfectly 
satisfied  to  have  their  dung-heaps  piled  up 
against  the  parlor  door.  They  treat  the 
matter  with  a  delightful  indifference. 
Can  the  medical  profession  go  on  being  sat- 
isfied to  have  this  social  dung-heap  de- 
posited against  its  own  door?  If  it  can, 
posterity  will  be  very  apt  to  deduct  some  of 
that  profession's  glory  won  in  other  fields. 

Frankly,  if  we  are  to  meet  this  common 
enemy  of  our  flesh — and  spirit,  and  van- 
quish him,  past  tactics  will  have  to  go  into 
the  discard  and  a  newer  kind  of  warfare  be 
employed, — a  standing-up  warfare  with 
face  forward,  and  an  unmistakably  plain, 
purposeful  and  sincere  expression  given 
to  our  will-to-win. 

Let  us  look  for  a  moment  into  the  merits 
of  this  term  Venereal,  with  which  from 
medieval  times  we  have  adorned  these  dis- 
eases, and  see  if  perhaps  our  foes  cannot 
be  more  successfully  fought  under  their 
separate  and  more  scientific  designations. 

From  Venus,  the  Eoman  goddess  of  love, 
as  is  perfectly  well-known,  came  the  term 
Venereal  to  be  applied  to  all  sores  and 


8  CONTROL  OF  SEX  INFECTIONS 

^'issues"  consequent  upon  sexual  inter- 
course. For  Gonorrhea,  Syphilis  and 
Chancroid  were  then  all  thought  to  be  but 
different  expressions  of  but  one  disease. 
That  misconception  has  now  been  scientifi- 
cally swept  away.  If  then  we  continue  to 
use  as  a  group  designation  of  these  three 
different  and  distinct  diseases  the  term 
Venereal  as  a  means  of  socially  stigmatiz- 
ing those  individuals  who  are  infected  mth 
these  maladies,  we  should  not  leave  out  of 
account  the  numberless  members  of  society 
who  while  exposing  themselves  continually 
to  these  infections,  are  not  infected.  Here 
is  a  discrimination  wliich  does  not  savor 
of  justice;  and  if  fair  play  is  not  to  be  a 
factor  in  a  battle  for  moral  betterment  the 
laurels  of  war  will  not  linger  long  on  the 
heads  of  the  victors.  Again,  with  the 
broader  social  knowledge  we  now  have  of 
these  diseases  we  know  that  they  shower 
their  curses  on  the  virtuous  wife  and  the 
unknowing  babe  with  the  same  stern  and 
relentless  fury  as  upon  the  veriest  rake. 
Furthermore,  we  know,  that  with  simple 
precautions  and  with  the  use  of  equally 


INTRODUCTION  9 

simple  antiseptic  measures  the  most 
vicious  are  fully  protected  from  these  in- 
fections, while  the  trusting  bride  or  the 
faithful  wife  is  thrust  into  a  lifetime  of 
purgatory,  and  blinded  and  otherwise 
blighted  babies  grow  up  to  useless  and 
burdensome  lives.  Once  more,  so  much  for 
the  justice  of  this  chastising  term,  Vene- 
real, which  must  follow  the  fouled  wife  or 
the  innocent  child  oftentimes  to  the  grave. 

The  ancients  thought  the  great  evil  lay 
in  acquiring  a  sexual  disease;  we  now 
know  that  it  is  a  greater  evil  to  transmit 
it.  But  the  greatest  evil  of  all  must  lie  in 
the  callous  indifference  which  allows  inno- 
cent women  and  children  to  become  its  vic- 
tims and  then  bathe  their  wounds  in  the 
wormwood  of  a  word  which  stains  their 
character. 

From  what  we  like  to  call  the  practical 
standpoint,  if  we  are  to  follow  out  a  suc- 
cessful campaign  against  these  diseases, 
infected  persons  and  carriers  of  disease 
should  not  be  driven  under  cover  by  the 
fear  of  an  odious  term,  which  too  often  is 
in  no  wav  deserved. 


CHAPTER  II 

UNDERLYING  CAUSES  OF  SEXUAL 
DISEASES 

The  mere  possession  of  a  rather  com- 
plete scientific  knowledge  of  the  germ  fac- 
tor in  relation  to  these  diseases  does  not, 
it  would  seem,  lessen  in  the  least  their  fre- 
quency or  persistence.  Text-book  teach- 
ing of  cause,  symptoms,  pathology  and 
treatment,  while  giving  perhaps  the  best 
instruction  for  the  successful  care  of  the 
individual  case,  furnishes  no  clue  as  to  their 
general  prevention.  It  becomes  necessary 
then  to  view  their  genesis  from  a  different 
angle  if  any  foot-hold  is  to  be  gained  in  a 
struggle  aimed  at  their  overthrow.  Thus 
it  is  that  one  is  forced  to  study  the  social 
conditions  which  furnish  soil  for  their 
growth,  if  the  roots  of  the  malady  are 
ever  to  be  reached.  So  closely  related  are 
our  sexual  declivities  and  diseases  with  our 

10 


CAUSES  OF  SEXUAL  DISEASES  11 

social  declivities  and  disorders  that  it  is 
impossible  to  study  the  course  of  the  latter 
without  uncovering  causes  of  the  former. 
Without  further  delay  then,  let  us  turn  our 
attention  to'  these  social  conditions. 

What  may  be  termed  the  ^^hush"  system 
will  make  an  excellent  opening  to  the  sub- 
ject matter  of  this  chapter.  It  is  that  awe- 
some, ubiquitous,  frowning  ^^hush"  pro- 
nounced like  a  whispered  hiss,  whenever 
the  subject  of  the  human  reproductive  func- 
tion in  any  of  its  phases  is  approached 
within  the  hearing  of  a  ^* child''  under 
twenty-four  or  five  years  of  age,  unless  of 
course  the  ** child''  is  by  that  time  a  parent 
itself.  This  '^hush"  was  no  doubt  in- 
tended to  keep  the  young  ^^pure"  and  in- 
nocent and  protected  from  ^* mistakes" 
which  might  lead  to  unfortunate  con- 
sequences— shadowy,  unrevealed  conse- 
quences— ^perhaps  to  the  contraction  of 
some  unmentionable  state  of  ill-health, 
which  might  break  out  in  unsightly  sores 
or  unredeemable  disgrace  to  the  family! 
This  in  a  rough  way  may  serve  to  illustrate 
the  traditional  treatment  of  the  matter  of 


12  CONTROL  OF  SEX  INFECTIONS 

sex  by  parents  and  teachers;  a  matter 
which  each  child  of  course,  ferrets  out  for 
itself  in  league  with  its  companions,  from 
such  literature  as  it  can  lay  its  hands  on, 
augmented  by  '^stories"  which  give  the 
finishing  touch  to  its  education  on  the 
'^physiology"  of  sex.  This  ''hush"  or 
keep-in-the-dark  system  has  been  made  a 
specialty  by  the  English-speaking  people. 
The  cost  of  it  in  precious  health  and  gen- 
eral moral  uprightness  has  been  very  great. 
If  space  permitted,  one  might  rehearse  by 
way  of  illustration  some  tragic  cases  in 
both  young  men  and  young  women,  vic- 
tims of  the  "hush"  method  of  rearing, 
who  have  come  under  personal  observa- 
tion, and  whose  bitter  experiences  could  be 
directly  laid  to  the  darkness  in  which  they 
had  been  kept  of  nature's  ways. 

The  direct  obligation  wliich  rests  upon 
the  parents  of  young  children  should  no 
longer  be  left  an  uncertainty,  and  in  the 
chapter  dealing  with  what  every  boy  and 
girl  should  be  taught,  the  parents'  part 
will  not  be  omitted. 

From  all  sides  should  come  nothing  but 


CAUSES  OF  SEXUAL  DISEASES  13 

the  truth  of  that  which  pertains  to  the 
sexual  side  of  life;  for  alas!  the  past 
policy  of  ministers  and  teachers  in  their 
guardianship  of  the  ^oung  needs  a  start- 
ling change.  The  unsettled  moral  attitude 
which  has  influenced  them  in  side-stepping 
this  whole  subject  adds  another  cause  to 
the  prevalence  of  sex  disease. 

By  this  time  the  perusing  physician 
who  is  trying  to  find  some  redeeming  point 
of  interest  in  all  this  setting  forth  of  an  un- 
savory subject  is  wondering  why  he  should 
be  called  upon  to  review  the  perfectly  ob- 
vious and  well-known  fact  of  parents'  and 
teachers'  neglect  in  preparing  their  chil- 
dren for  the  sexual  pitfalls  in  their  path. 
Why  indeed  should  the  medical  man  be  re- 
minded of  parents'  and  teachers'  short- 
comings even  though  it  is  the  beginning  of 
such  a  vast  amount  of  sexual  morbidity? 
We  will  let  the  answer  be  straight  from 
the  shoulder.  Because  the  medical  man 
and  the  medical  man  alone  is  the  source 
of  actual  knowledge  on  this  subject. 

What  physician  is  there  who  has  seen 
laid  bare  by  the  knife  the  pelvic  contents 


14  CONTROL  OF  SEX  INFECTIONS 

of  a  woman  diseased  and  destroyed  by  a 
gonococcus  infection — seen  her  rendered 
sexless  by  the  necessity  of  the  case — seen 
her  rendered  physically  and  perhaps  men- 
tally unstable  by  the  same  token,  and  who 
has  not  cried  out  within  himself  against 
the  injustice  of  our  unbalanced  social  life! 
What  physician  is  there  who  has  seen  a 
number  of  babies  blinded  by  the  same  or- 
ganism or  the  children  tainted  by  syphilitic 
parents,  whose  very  soul  has  not  revolted 
at  the  sight,  and  yet, — and  yet  how  little 
have  we  as  doctors  taken  the  fact  to  heart, 
that  we  alone  are  the  only  ones  armed 
with  that  knowledge  which  can  save  so- 
ciety so  much,  so  very  much,  of  this  wast- 
age, if  we  each  did  our  part  in  the  general 
dissemination  of  the  facts  in  the  case  of 
these  danger  points  ahead? 

What  have  our  laws  done  to  promote 
morality,  or  to  prevent  sexual  infections? 
Take  the  case  of  professional  prostitution 
which  many  look  upon  as  the  most  fertile 
source  of  these  infections,  which  it  is  not. 
The  law  aims  to  suppress  and  dislodge  and 
thus  finally  to  extinguish  prostitution ;  and 


CAUSES  OF  SEXUAL  DISEASES  15 

it  does  not  do  it.  The  records  of  such  ac- 
tion in  all  countries  and  for  all  recorded 
time  shows  prostitution  still  in  a  flourish- 
ing condition.  One  niay  almost  say  that  it 
grows  lusty  on  the  processes  of  laws  to 
abolish  it.  Some  of  the  mightiest  emper- 
ors who,  it  is  said,  tried  to  enforce  such 
regulations  could  not  themselves  always 
obey  their  own  moral  ordinances.  It  is  so 
much  easier  to  make  laws  to  regulate  con- 
duct than  to  go  to  the  bother  of  bringing 
up  the  young  from  birth  with  a  sense  of 
respect,  let  us  even  say  reverence  if  you 
choose,  for  honesty  and  order  and  morality. 
What  was  it  the  ancient  Jesuit  priests  used 
to  say?  ^^Give  us  a  child  until  it  is  seven 
and  you  can  have  it  after  that.'^  They 
knew  when  the  corner-stone  of  life's  con- 
duct was  laid.  In  its  wisdom  the  law 
seizes  many  objects  of  art  and  paintings 
as  obscene,  while  the  obscenity  is  in  the 
minds  which  think  evil.  Obscenity  is  sub- 
jective, not  objective.  We  need  not  hope 
for  reform  to  come  from  zeal  alone,  it 
must  be  flavored  with  intelligence.  One 
reads  that  in  the  State  of  New  York  in 


16  CONTROL  OF  SEX  INFECTIONS 

1907  a  law  was  passed  rendering  any 
one  guilty  of  adultery  punishable  by  six 
months^  imprisonment,  or  a  heavy  fine,  or 
both.  It  was  expected  that  the  law  would 
act  to  prevent  adultery.  In  less  than  three 
months  after  this  Act  became  a  law,  law- 
yers came  to  the  conclusion  it  was  a  dead 
letter.  In  the  two  years  following  its  en- 
actment there  were  the  usual  large  number 
of  divorces,  but  only  three  people  were  sent 
to  prison  for  a  few  days  under  this  Act, 
and  but  four  fined  a  small  sum.  The 
reader  may  judge  for  himself  how  much 
e:ffect  this  law  had  against  immorality,  or 
what  its  value  was  in  checking  commercial- 
ized vice.  The  ^^Eaines  Law''  is  another 
enactment  with  a  history.  With  the  idea 
of  regulating  the  sale  of  liquor  it  achieved 
the  most  wholesale  prostitution.  As  a 
learned  writer  once  said,  ^^all  the  repres- 
sion in  the  world  can  only  touch  the  surface 
of  life." 

We  have  mentioned  the  fact  that  the  pro- 
fessional prostitute  is  not  the  greatest 
source  of  infection.  This  matter  was  gone 
into  with  great  care  both  before  and  dur- 


CAUSES  OF  SEXUAL  DISEASES  17 

ing  the  war,  and  it  was  found,  notably 
in  Great  Britain,  that  only  a  little  more 
than  one  quarter  of  the  infections  in  men 
were  derived  from  the  professional  prosti- 
tute. This  is  not  difficult  of  explanation, 
as  those  depending  on  prostitution  for  a 
living  know  much  better  how  to  keep  them- 
selves free  from  infection.  But  from  the 
casual  participant,  the  working  girl  from 
the  shop  or  factory  or  servant  class  or 
those  who  idle  at  home,  the  percentage  of 
infections  was  almost  three-quarters  of  the 
total  on  the  tabulations  made.  This  is 
doubly  unfortunate  as  these  girls  not  yet 
cut  otf  from  self-respecting  sources  of  sup- 
port still  carry  the  hope  of  husbands  and 
homes.  Let  us  now  move  backward,  as  it 
were,  and  see  if  we  can  tell  where  the  re- 
sponsibility rests  for  this  vast  group  of  in- 
fected and  oftentimes  sexually  ruined  in- 
dustrial workers  who  ignorantly  spread 
the  majority  of  the  sexual  havoc  to  all 
classes  of  society.  First,  it  is  just  as  well 
to  look  at  some  of  the  facts  in  the  matter. 
In  Great  Britain,  and  on  a  much  larger 
scale  here  in  America,  in  all  important  in- 


18  CONTEOL  OF  SEX  INFECTIONS 

dus  trial  and  commercial  centers  is  seen  the 
general  employment  of  women, — young 
women  between  the  ages  of  seventeen  and 
thirty.  For  it  is  just  these  girls  in  their 
home-making  and  child-bearing  period  of 
life  who  seem  to  be  most  profitable  to  in- 
dustry and  its  ends.  Many  interesting 
questions  and  thoughts  come  to  the  surface 
of  the  mind  when  one  takes  in  the  idea  of 
all  these  thousands  upon  thousands  of 
young  women  in  the  flower  of  maternal 
possibility,  losing  the  opportunity  in  so 
many  instances  of  home-making  and 
motherhood,  and  thus  gaining  freedom 
from  temporizing  sexual  experiences,  be- 
cause department  stores  and  offices  and 
factories  can  offer  to  their  young  and  im- 
pressionable natures  more  bright  lights 
and  tinsel  than  the  more  enduring  and 
further-sighted  satisfactions  of  marriage 
can  ofPer.  Or  are  we  figuring  without  our 
host?  Is  it  that  there  are  not  enough  hus- 
bands for  these  young  women,  and  that 
they  represent  only  the  surplusage  of  the 
female  sex?  If  this  is  so,  then  by  all 
means  let  us  encourage  modern  industry 


CAUSES  OF  SEXUAL  DISEASES  19 

and  commerce  to  make  all  the  money  it  can 
out  of  these  girls  and  to  employ  these  pos- 
sible mothers  and  help  them  by  hard  work 
and  excitement  to  suppress  and  try  to  for- 
get their  natural  instincts.  But  we  find  that 
very  large  numbers  of  these  girls  have 
their  transitory  lovers  and  at  least  the 
threshold  of  their  sex  instinct  is  not  denied 
expression,  and  we  immediately  are  curi- 
ous to  know  why  these  are  denied  the  full 
satisfaction  of  nature's  most  imperative 
demand,  that  of  reproducing.  This  then 
must  bring  us  a  step  closer  to  the  truth  of 
the  answer  that  we  are  seeking:  that  the 
flaw  is  somewhere  in  the  social  system  we 
are  struggling  under  if  it  withholds  the 
birthright  privilege  of  mating  and  beget- 
ting its  kind  to  this  very  large  percentage 
of  our  people.  Let  us  say  then  if  it  is  the 
economic  factor  that  cuts  off  from  so  many 
young  people  the  opportunity  to  marry 
early  and  have  homes  and  families  it  is 
economics  gone  wrong,  as  the  home  is  the 
economic  as  well  as  the  moral  keystone  of 
the  social  arrangement  we  like  to  call  civil- 
ization.   If  it  was  possible  to  set  up  our 


20  CONTROL  OF  SEX  INFECTIONS 

form  of  civilization  on  the  basis  of  the  indi- 
vidual and  independent  home,  as  we  did 
when  we  were  money  poor  and  mechani- 
cally unborn,  it  would  be  no  impossible  task 
to  continue  it  now,  barring,  of  course,  some 
costly  vanities  we  have  fallen  in  the  way  of. 

We  find  then  after  this  excursion  into  our 
social  conditions  that  there  is  a  vast  deal 
of  sexual  infection  kept  moving  about  by 
reason  of  the  fundamental  error  of  an  in- 
dustrial and  commercial,  or  if  you  like 
social  system,  which  rears  such  a  barrier  to 
early  marriage  and  home  life,  forgetting 
that  home  life  is  not  only  the  safest  eco- 
nomics, but  is  the  safest  and  best  protec- 
tion against  sexual  diseases. 

As  to  the  extent  of  this  costly  and  degen- 
erating plague  which  destroys  so  much  of 
life's  happiness  and  purpose,  some  idea 
will  be  gained  through  the  inventory  re- 
vealed by  the  records  of  the  war. 

To  recapitulate,  we  find  the  following 
items  to  be  outstanding  social  factors  as 
underlying  causes  of  our  sexual  diseases. 

(1)  The  system  of  silence  on  matters  of 
sex;  the  parents'  responsibility. 


CAUSES  OF  SEXUAL  DISEASES  21 

(2)  Maintaining  the  policy  of  silence  and 
the  deception  of  the  young  as  to  the  truth 
of  sexual  affairs,  by  teachers  and  ministers. 

(3)  The  physician's  obligation  to  society, 
how  this  has  been  neglected. 

(4)  Laws  regulating  sexual  morality; 
and  their  utter  futility. 

(5)  Prostitution  as  a  source  of  infection. 

(6)  Alcohol.  This  is  placed  in  a  chapter 
by  itself. 

(7)  Industrialism  which  might  well  have 
been  treated  separately  in  a  special  chap- 
ter; and  of  which  more  will  appear  later. 


CHAPTER  III 

WHAT  THE  WAR  HAS  REVEALED 

TMs  chapter  would  be  a  considerable 
volume  in  itself  were  it  to  contain  in  any 
degree  of  detail  the  story  of  the  costly 
consequences  laid  upon  the  world  by  the 
sexual  diseases  in  the  war  from  which  we 
are  just  emerging.  In  periods  of  peace  a 
vast  deal  of  human  energy  can  escape  with- 
out much  attention  being  attracted  to  it; 
but  in  a  period  of  mortal  conflict  where 
every  ounce  of  available  man  power  is 
needed  our  senses  are  soon  sharpened  to 
detect  the  loss  of  fighting  force  which  may 
cost  us  everything  we  are  fighting  for.  So 
it  was  through  expediency,  we  must  con- 
fess, rather  than  through  any  commendable 
sense  of  morality,  that  we  came  upon  a 
very  dramatic  exposure  of  society's  inner 
structures. 

22 


WHAT  THE  WAR  HAS  REVEALED  23 

Rather  than  go  into  statistical  complexes 
to  illustrate  the  dimensions  of  this  social 
shame  which  our  indifference  in  the  past 
has  so  successfully  fertilized,  our  purpose 
here  will  be  satisfied  if  by  contrasts  rather 
than  counts  (although  a  few  figures  will  be 
necessary)  a  general  idea  of  the  degrading 
plague  we  have  so  placidly  entertained,  can 
be  given,  and  which  the  records  of  our 
recent  war  experiences  have  pointed  out 
afresh. 

Inasmuch  as  the  structure  of  society  is 
merely  a  reflection  of  the  individuals  in  it, 
and  that  the  responsibility  for  its  quality 
rests  on  each  one  personally  and  in  propor- 
tion to  that  one's  knowledge,  it  will  soon 
be  seen  how  personally  interesting  becomes 
the  subject  matter  of  this  chapter. 

The  first  jolt  to  our  national  pride  was 
registered  with  the  initial  draft  of  a  million 
men  in  which  Sexual  Diseases  took  first 
place  among  the  infectious  conditions  met 
with.  Of  all  physical  defects  save  flat  foot 
and  hernia,  which  were  more  numerous,  the 
Sexual  Diseases  as  represented  by  Gonor- 
rhea,   Chancroid    and   Syphilis   were    the 


24  CONTROL  OF  SEX  INFECTIONS 

commonest  conditions  of  disease  or  defect 
encountered. 

Through  wide-spread  educational  cam- 
paigns the  common  evil  of  tuberculosis  has 
become  well  recognized.  This  group  of 
diseases, — the  sexual  infections, — was 
found  to  be  even  more  numerous. 

The  question  which  naturally  arises  in 
the  mind  is:  Just  how  numerous  were 
they?  Quoting  the  Surgeon-General's  Ee- 
port  of  1919  to  the  Secretary  of  War,  Vol. 
I,  page  48,  it  reads:  ''For  venereal  dis- 
eases during  1917-18,  259,612  cases  were 
recorded  for  enlisted  men  in  the  United 
States. ' '  There  it  is,  in  black  and  white — 
a  record  which  is  probably  as  accurate  as 
has  ever  been  made  of  these  diseases;  ac- 
curate at  least  as  a  minimum  basis,  for 
there  were  at  any  rate  that  many  recorded. 
Let  the  reader  pause — and  if  he  can,  take 
in  something  of  the  meaning  of  these 
figures.  High  figures  in  these  days  we  are 
very  apt  to  brush  away,  as  either  too  com- 
mon or  too  incomprehensible.  Then  let  us 
think  over  the  potential  tragedy  of  just 
one  case  and  let  our  imagination  carry  that 


WHAT  THE  WAR  HAS  REVEALED  25 

single  one  through  its  possible  social  rami- 
fications of  disease  and  disgust  as  it  may 
be  conveyed  from  man  to  woman,  from 
woman  to  child,  with  its  trail  of  complica- 
tions and  catastrophes.  And  then  try  and 
conceive  a  quarter  of  a  million  of  these 
loathsome  diseases  in  just  a  given  group — 
a  sample  group  if  you  choose — in  a  given 
period  in  a  small  percentage  of  our  popu- 
lation. It  is  monstrous,  it  is  almost  un- 
thinkable— and  yet  there  it  is — the  fact. 

But  some  may  think  these  figures  do  not 
represent  the  sexual  disease  conditions  as 
they  exist  in  civil  life ;  that  it  was  the  army 
life  which  provoked  this  high  percentage. 
Let  such  minds  be  disabused,  for  on  the 
contrary  the  rate  of  these  infections  went 
do^vn  while  the  men  were  in  the  military 
service.  For,  for  the  first  time  in  their 
lives  in  the  almost  universal  majority  of 
cases  they  were  instructed  and  otherwise 
safeguarded  from  these  infections.  In  the 
same  army  report  quoted  above  facts  are 
put  forth  to  show  as  the  record  reads  that 
^'Approximately  three-fourths  of  all  cases 
that  were  recorded  in  the  Army  that  were 


26  CONTROL  OF  SEX  INFECTIONS 

stationed  in  the  United  States  during  the 
two  years  were  brought  into  the  Army 
from  civil  life.  The  Medical  Department 
of  the  army  is  very  careful  to  leave  no 
misapprehension  in  the  mind  on  that  score. 
And  it  has  a  right  to  take  a  just  pride  in  its 
special  work  in  the  prevention  of  these  dis- 
eases which  it  has  been  closely  f  ollomng  up 
since  1909  when  its  campaign  of  preventive 
medicine  as  applied  to  sexual  infections 
was  begun.  Unhappily  the  army  does  not 
have  the  same  opportunity  that  is  given  in 
civil  life  to  influence  aright  the  minds  of 
men  from  birth  and  to  surround  them  with 
the  early  home  environments  which  so 
largely  determines  the  after  life  of  every 
individual. 

As  showing  the  result  of  the  physical 
examinations  conducted  in  the  draft  of  the 
see-ond  million  men  from  civil  life  inducted 
into  military  service  the  following  quota- 
tion from  the  report  made  by  the  Surgeon- 
General  to  the  Senate  Committee  1919  will 
be  of  interest :  '  ^  This  rate  of  5.6  per  cent, 
for  all  forms  of  venereal  disease  together, 
as  shown  in  the  second  million  men,  must 


WHAT  THE  WAR  HAS  REVEALED  27 

be  taken  as  the  most  precise  information 
we  have  concerning  the  proportion  of  men 
in  the  United  States,,  ages  18  to  30,  who 
show  symptoms  of  venereal  disease  at  a 
given  time."  Five  and  six-tenths  per  cent., 
which  means  more  than  one  in  every  eight- 
een, showed  symptoms  of  infection.  There 
is  no  whitewashing  this  minimum  record 
of  facts  nor  slipping  from  under  that  share 
of  personal  responsibility  which  rests  on 
every  citizen  of  an  enlightened  country 
who  maintains  a  Social  state  of  things 
which  made  that  record  possible.  But  let 
us  examine  a  little  more  carefully  into  those 
figures  which  would  stamp  one  out  of 
eighteen  of  any  given  group  of  a  million 
of  our  young  men  between  18  and  30  with 
a  sexual  disease.  The  report  reads  ^^who 
show  symptoms.'^  Now  those  who  know 
the  nature  of  these  diseases — Gonorrhea, 
Syphilis  and  Chancroid — know  that  the 
first  two — Gonorrhea  and  Syphilis — which 
are  the  most  important,  the  most  far-reach- 
ing and  which  represent  eighty  to  ninety 
per  cent,  of  the  groups — (Gonorrhea  alone 
representing    sixty   to    eighty   per   cent.) 


2S      COXTROL  OF  SEX  IXFECTIOXS 

know  that  these  diseases  have  not  finished 
their  course,  nor  their  infectiousness,  nor 
their  liability  to  disabling  complications 
simply  because  they  do  not  show  symptoms. 
It  is  also  well  known  that  gonorrhea  and 
syphilis  run  long  periods  oftentimes  when 
they  show  no  symptoms  and  that  only  by 
the  most  searching  microscopical  and  lab- 
oratory tests  are  we  able  to  demonstrate 
their  presence.  In  all  this  there  is  no  hos- 
tile criticism  of  the  methods  of  the  draft 
board  examiners,  for  even  though  they  had 
had  the  experienced  men  and  the  necessary 
laboratory  equipment  at  hand  they  had  not 
the  time  available  for  the  exacting  tests 
by  which  to  arrive  at  the  true  number  of 
sexually  infected  men  passing  before  them. 
So  as  a  minimum  estimate  we  can  take  the 
5.6  per  cent,  as  correct  for  those  men  who 
were  openly  and  obviously  suffering  from 
a  sexual  disease ;  but  the  numbers  of  gonor- 
rhea cases  in  which  there  was  no  urethral 
discharge,  and  where  the  urine  was  clear 
and  the  genitals,  external  and  internal, 
(though  I  doubt  if  the  latter  were  fre- 
quently examined),  gave  no  obvious  evi- 


WHAT  THE  WAR  HAS  REVEALED  29 

dence  of  infection  to  the  sight  or  touch, 
must  have  been  very  great.  Personal  evi- 
dence of  this  was  given  to  me  in  very  large 
groups  of  men  pouring  into  one  of  the  can- 
tonments, who  arriving  free  from  any  ob- 
vious symptoms  of  gonorrhea,  developed 
active  recurrence  of  all  these  symptoms 
which  might  have  been  quiescent  for  many 
weeks  or  even  months  in  civil  life,  but 
with  the  radical  changes  of  living  condi- 
tions and  the  burden  of  unaccustomed  ex- 
ercises in  drilling  and  the  like  were 
brought  into  evidence  again.  Of  syphilis 
this  was  not  so  much  the  case,  but  even 
with  syphilis  there  were  considerable  num- 
bers who,  passing  the  draft  board  as  free 
from  this  infection,  bloomed  out  later  on 
in  camp.  All  this  convinces  the  writer 
that  the  percentage  of  5.6  is  very  much  too 
low,  and  that  the  army  is  credited  with  a 
greater  number  of  infections  which  came 
directly  from  our  civil  life  plan  of  sanita- 
tion, and  for  which  the  army  was  in  no 
way  responsible. 

A  very  vivid  impression  of  the  costli- 
ness of  these  sexual  infections  is  arrived 


30  CONTROL  OF  SEX  INFECTIOi^S 

at  by  the  report  of  the  Surgeon-General, 
which  gives  the  time  lost  by  the  soldiers 
thus  infected.  It  reads  thus:  *^The  loss 
of  time  for  venereal  diseases  for  the  year 
(1918)  amounted  to  3,937,710  days." 
Which  disregarding  a  fraction  figures  out 
to  mean  10,788  years. 

Here  is  a  subject  for  the  enterprising 
social  economist  to  give  us  some  ideas  on, 
and  if  the  matter  of  lost  time  is  carried 
to  the  estimation  of  days  lost  in  our  civil 
life  population  omng  to  these  diseases, 
where  we  can  include  the  wives  made  life- 
long invalids,  the  blinded  babies  which  must 
be  largely  supported  for  a  lifetime,  the 
cases  of  locomotor  ataxia,  paresis  and  a 
number  of  lesser  disabling  disorders  which 
abound  in  private  life  and  in  our  State 
supported  hospitals  and  asylums,  we  shall 
see  what  an  appalling  period  of  time  is  un- 
necessarily lost,  and  what  a  financial  bur- 
den the  support  of  these  victims  of  pre- 
ventable diseases  we  each  of  us  share. 

It  makes  no  difference  whether  these  dis- 
eases are  more  numerous  in  the  Southern 
States  or  less  prevalent  in  the  Northern 


WHAT  THE  WAR  HAS  REVEALED  31 

States.  That  we  have  allowed  them  to 
become  so  alarmingly  prevalent  in  both 
rural  and  urban  communities  both  North 
and  South  is  the  thing  to  be  kept  firmly  in 
mind.  In  this  connection  it  is  of  no  little 
interest  to  note  that  acording  to  the  draft 
board  findings  the  increment  of  sexual  in- 
fections was  somewhat  greater  from  the 
country  than  from  the  cities. 

Early  in  our  war  experience  it  became 
evident  to  the  commander  of  our  forces 
abroad  that  to  send  men  infected  with 
gonorrhea  and  syphilis  overseas  would 
only  add  to  our  burdens  and  overtax 
France  where  accommodations  and  fuel 
were  none  too  plentiful;  so  the  orders  came 
to  send  overseas  no  soldiers  thus  infected. 
The  consequence  was  that  in  the  camps  and 
the  ports  of  embarkation  these  men  were 
continually  increasing  as  they  were  being 
taken  into  the  service  until  they  were 
banked  up,  as  it  were,  in  camp  hospitals 
and  quarters  and  later  on  in  development 
battalions,  so  called.  At  some  points  they 
reached  in  numbers  to  many  thousands. 
They    became    embarrassingly   numerous. 


32  COXTROL  OF  SEX  INFECTIONS 

and  to  the  government  increasingly  costly. 
Methods  of  collective  treatment  nnder  un- 
favorable circumstances,  both  as  to  equip- 
ment and  expert  care,  were  slowly  set  in 
operation.  By  the  autumn  of  1918  some 
order  was  coming  out  of  the  former  con- 
fusion, and  at  some  points  there  was 
promise  of  establishing  a  uniform  and 
scientific  form  of  treatment.  Then  came 
the  armistice.  Up  went  shouts  of  relief 
from  soldiers  and  citizens,  and  for  a  period 
down  went  discipline  and  decorum  every- 
where. And  yet  as  far  as  the  Sexual  Dis- 
ease problem  was  concerned,  there  came  at 
that  moment  an  opportunity  of  golden 
rarity.  For  here  on  the  one  hand  were 
these  thousands  upon  thousands  of  sex- 
ually infected  soldiers;  still  in  the  army; 
still  under  complete  control.  On  the  other 
hand  here  was  the  housing  and  the  equip- 
ment and  an  increasing  promise  of  real 
scientific  treatment  ready  to  undo  their 
infectiousness  and  teach  them  the  lesson 
of  their  danger  to  the  community  and  to 
themselves,  of  uncured  sexual  infection. 
Here  was  the  chance  to  keep  them  until 


WHAT  THE  WAR  HAS  REVEALED  33 

they  were  free  from  infection  and  then 
send  them  back  to  their  homes  and  fellow 
men,  clean  in  body,  strong  in  better  re- 
solves,— apostles  of  a  new  view  of  health 
and  decency,  to  take  with  them  everywhere 
they  went.  I  have  no  doubt  more  than  one 
saw  this  moment  of  opportunity  which 
would  prevent  these  thousands  of  active 
volcanoes  of  infectiousness  with  their  army 
restraint  thrown  otf,  from  rushing  back 
to  their  civil  communities  to  plant  their 
seeds  of  disease.  I  have  no  doubt  but  that 
more  than  one  wrote  earnestly  appealing 
to  the  authorities  in  Washington  to  further 
the  obvious  plan  which  would  safeguard 
the  civil  communities  from  the  danger 
which  the  premature  release  of  these  in- 
fected soldiers  was  sure  to  cause.  Nor  was 
the  Medical  Department  of  the  Army  at 
Washington  unresponsive  to  appeal  or  un- 
prepared with  a  plan  to  keep  these  in- 
fected cases  until  they  were  free  from  in- 
fection. Orders  were  issued  that  they 
would  be  restrained  and  kept  under  treat- 
ment until,  by  the  usual  tests,  it  was  con- 
sidered safe  to  have  them  return  to  their 


34  CONTROL  OF  SEX  INFECTIONS 

homes.  The  first  orders  to  this  effect  were 
quite  strict.  Following  orders  were  a  little 
less  severe.  The  other  soldiers  in  the 
camps  were  rapidly  being  demobihzed. 
It  is  httle  wonder  that  those  being  retained 
for  treatment  were  restive  and  ill-satisfied 
mth  their  lot.  Perhaps  their  relatives 
and  friends  in  their  home  towns  let  their 
representatives  know  their  anxiety  to  see 
the  boys  again.  The  ranks  of  infected  ones 
dwindled.  Perhaps  those  who  were  di- 
rectly caring  for  them  had  visions  of  home 
too,  and  became  optimistic  over  the  pro- 
gress toward  cure  which  these  multitudes 
of  infected  men  showed.  The  army  got 
smaller.  In  all  departments  it  went  on 
shrinking.  Both  the  well  and  the  sick 
seemed  steadily  to  grow  less.  I  have  no 
doubt  that  some  of  these  sexually  diseased 
were  rendered  non-infectious  before  they 
were  allowed  to  leave,  perhaps  a  few  of 
them  were  even  cured, — but  the  great  op- 
portunity was  missed.  Politically  speak- 
ing,— we  slipped  by. 

There  has  already  been  enough  written 
in  this  chapter  to  leave  a  pretty  firm  belief 


WHAT  THE  WAR  HAS  REVEALED  35 

in  the  fact  that  the  war  has  given  a  fairly 
good  inventory  of  our  social  status  as  re- 
gards Sexual  Diseases;  but  it  has  not  yet 
given  a  full  account  of  how  much  the  war 
has  increased  this  highly  undesirable  stock 
of  disease. 

It  is  impossible  to  do  this  for  the  very 
good  reason  that  the  recording  of  our  in- 
crement of  these  infections  in  France  after 
the  signing  of  the  armistice,  fell  to  the 
ground  and  the  inspections  so  frequently 
held  of  returning  officers  and  men  was  a 
form.  The  true  number  of  those  infected 
after  the  signing  of  the  armistice  can  never 
be  known.  It  is  also  impossible  because 
we  have  no  records  to  show  the  spread  of 
these  diseases  in  our  civil  communities  by 
the  men  we  have  been  referring  to,  and  who 
were  released  on  the  public  without  the 
searching  microscopical  and  other  tests  es- 
sential to  a  fair  presumption  of  non-in- 
fectiousness. 

For  all  that  the  Medical  Department  of 
our  army  stands  unique  as  among  our  civil 
institutions  in  the  interest  and  the  effort 
put  forth  by  it  to  cope  with  sexual  in- 


36  CONTROL  OF  SEX  INFECTIONS 

fections;  and  to  the  army  and  navy  and 
U.  S.  Public  Health  Service  the  civil  popu- 
lation of  this  country  owes  a  debt  of  grati- 
tude for  the  program  devised  and  the 
methods  of  instruction  pursued;  for  they 
have  put  new  and  valuable  knowledge  into 
the  minds  of  the  army  of  men  who  were 
quite  innocent  of  these  vital  things  when 
the  Government  took  them  from  civil  life. 
In  Great  Britain  also  a  rude  awakening 
in  this  matter  of  Sex  Disease  has  been  dealt 
to  its  people.  During  the  spring  months 
of  1918  I  was  given  the  opportunity  while 
in  England  to  visit  and  study  at  first  hand 
a  fairly  representative  number  of  the  hos- 
pitals devoted  to  the  care  of  soldiers  suffer- 
ing from  sexual  infections.  Four  years  of 
face-to-face  experience  with  these  diseases, 
and  the  consequent  distraction  of  sorely 
needed  man-power,  had  awakened  the 
British  nation  to  a  new  sense  of  their  sex 
disease  situation;  but  they  met  that  situa- 
tion with  the  same  quiet  determination  and 
purpose  which  they  have  shown  through- 
out their  war  experience.  If  civil  life  con- 
ditions as  regard  to  these  diseases  were 


WHAT  THE  WAR  HAS  REVEALED  37 

bad  in  the  United  States,  they  were  no 
better  with  the  English ;  but  they  were  com- 
pelled to  call  into  play  more  drastic  meas- 
ures with  which  to  deal  with  them.  So  if 
we  find  them  in  the  immediate  future,  as 
present  signs  indicate,  coping  with  the 
sexual  disease  problem  on  a  broader  and 
more  intelligent  basis  than  we  in  the 
United  States  are  pursuing,  we  must  bear 
in  mind  that  the  war  imposed  more  suffer- 
ing in  this  matter,  as  it  did  in  every  other 
department  of  life,  on  our  English  friends 
across  the  sea.  To  derive  some  idea  of 
the  number  of  effectives  continuously  out 
of  action  through  these  diseases,  let  us  note 
the  number  of  hospital  beds  which  were 
provided  for  them ;  early  in  1918  there  were 
about  20,000  beds  and  more  special  hos- 
pitals for  their  use  being  built.  For,  be  it 
kno^vn,  the  English  had  the  wisdom  to  build 
quite  early  in  the  war  hospitals  devoted 
exclusively  to  these  cases,  and  to  these  hos- 
pitals properly  equipped  and  well  manned 
by  expert  medical  officers  the  patients  were 
directly  sent  before  there  was  opportunity 
for  the  mismanagement  of  their  infections 


38      CONTROL  OF  SEX  INFECTIONS 

by  unskilled  methods.  Some  of  these  hos- 
pitals had  a  capacity  of  as  high  as  three 
thousand  beds — larger  by  far  than  the 
largest  hospital  in  New  York  City.  Like 
ourselves  here  in  the  United  States  the 
British  have  taken  up  the  matter  of  the 
future  prevention  of  these  infections,  only 
with  the  British  public  it  has  become  a 
burning  topic.  The  English  people  seem 
at  last  to  see  in  it  the  menace  that  it  is 
to  national  health,  happiness  and  prosper- 
ity, and  by  public  discussion  they  are  work- 
ing out  their  own  problem. 


CHAPTER  IV 

THE  ROLE  OF  ALCOHOL  IN  THE 

SEXUAL  INFECTIONS  AND 

FECUNDATION 

There  is  little  doubt  that  the  majority 
of  sexual  infections  in  the  male  have  been 
contracted  under  the  influence  of  alcohol. 
Not  deeply  under  the  influence  of  alcohol, 
but  enough  so  that  temporarily  the  hold 
is  lessened  upon  the  steering  gear  of  con- 
duct; so  that  the  judgment  is  blurred  and 
undue  risks  are  taken ;  and  subsequent  pre- 
cautions of  disinfection  are  neglected.     To 
the  vast  consequences  of  this  fact  is  owed 
the   larger   number   of   male    sex  disease 
carriers.     The  next  process  in  which  alco- 
hol plays  a  ruinous  role  is  to  sufficiently 
blunt  the  conscience  and  banish  reflection 
so   that  the   infected  male   transfers   his 
malady. 

By  aid  of  alcohol  men  are  often  enabled 

39 


40      CONTROL  OF  SEX  INFECTIONS 

to  induce  girls  to  take  the  first  sexual  step. 
This  again  may  be  complicated  by  the  con- 
ditions just  referred  to  where  an  infected 
man  is  the  seducer. 

Thus  it  would  seem  that  to  alcohol  a  mul- 
titude of  miseries  are  due. 

To  those  who  are  under  treatment  for 
a  sexual  infection,  notably  gonococcus  in- 
fection or  syphilis,  the  ingestion  of  alco- 
holic drinks  works  the  greatest  harm.  The 
value  of  the  treatment  may  be  entirely 
vitiated,  and  more,  the  disease  is  very 
likely  to  be  increased,  or  new  complications 
developed.  It  is  not  yet  entirely  certain 
that  the  larger  number  of  cases  of  loco- 
motor ataxia  and  paresis  are  not  induced 
by  the  toxic  influence  of  alcohol  added  to 
the  processes  of  the  spirochseta.  So  it  is 
not  difficult  to  deduce  that  in  the  realm  of 
sexual  infections  alcohol  is  a  baneful  fac- 
tor. Can  it  be  also  that  the  toxic  influence 
of  alcohol  changes  the  early  resistance  of 
the  healthy  tissues  so  that  in  the  presence 
of  the  gonococcus  or  the  spirochseta  these 
organisms  more  readily  gain  a  foothold? 
This  is  a  question  of  no  little  importance. 


THE  ROLE  OF  ALCOHOL  41 

That  alcohol  has  a  depraving  effect  on 
the  genetic  sense  is  seen  by  its  ability  to 
turn  se:^ual  appetite  to  sexual  phantasy, 
and  thus  on  to  sexual  perversion  in  those 
with  latent  tendencies  in  this  direction. 

But  what  is  of  the  greatest  consequence 
and  perhaps  of  broader  significance  than 
anything  yet  attributed  to  alcohol  is  the 
part  it  plays  in  Fecundation.  Although 
this  subject  at  first  glance  may  seem  to  be 
somewhat  apart  from  the  care  and  control 
of  sexual  infections  it  is  in  reality  very 
intimately  related  to  these  questions;  far 
with  a  sufficiently  thick  sprinkling  of  con- 
genitally  subnormal  children  destined  to 
grow  up  to  be  uncontrolled  men  and  women, 
it  is  useless  to  hope  to  achieve  the  preven- 
tion of  any  social  evil.  For  data  regard- 
ing this  subject  I  shall  quote  from  Forel, 
the  famous  Swiss  psychiatrist,  in  his  book 
on  the  Sexual  Question  in  which  he  says  in 
regard  to  the  relative  evil  of  alcohol: 
'^But  what  is  of  much  greater  importance 
is  the  fact  that  acute  and  chronic  alcoholic 
intoxication  deteriorates  the  germinal  pro- 
toplasm   of    the   procreators."     He    then 


42  CONTROL  OF  SEX  INFECTIONS 

calls  attention  to  the  Swiss  census  of  1900, 
in  which,  there  figured  nine  thousand  idiots, 
and  after  careful  examination  of  the  bul- 
letins concerning  them,  it  was  shown  that 
there  were  two  acute  annual  maximum  pe- 
riods for  the  conception  of  these  idiots, 
calculated  back  nine  months  from  birth; 
the  periods  of  carnival  and  vintage,  when 
the  people  drank  most.  ^*In  the  wine- 
growing districts  the  maximum  conception 
of  idiots  at  the  time  of  vintage  is  enormous, 
while  it  is  almost  nil  at  other  periods. 
Moreover,  these  two  maximum  periods 
come  at  the  time  of  year  when  conception 
is  at  a  minimum  among  the  rest  of  the 
population;  the  maximum  of  normal  con- 
ception occurring  at  the  beginning  of 
summer.  ^ ' 

'^The  offspring*  tainted  with  alcoholic 
blastophthoria  suffer  from  various  bodily 
and  physical  anomalies,  among  which  are 
dwarfism,  rickets,  a  predisposition  to 
tuberculosis  and  epilepsy,  moral  idiocy  and 
idiocy  in  general,  a  disposition  to  crime  and 
mental  diseases,  sexual  perversions,  and 
many  other  misfortunes." 


THE  ROLE  OF  ALCOHOL  43 

Here  indeed  is  succulent  food  for  the 
thoughtful  mind;  but  it  would  be  rash  to 
make  the  statement  tjiat  prohibition  of  al- 
cohol is  the  solution  of  these  difficulties  we 
have  just  described. 

It  is  safe  to  say,  however,  that  the  coun- 
tries which  build  themselves  up  and  pro- 
gress, and  which  prevent  in  no  way  the 
individual  rights  of  the  people,  will  in  the 
presence  of  alcohol  and  many  other  dangers 
reach  more  rapidly  a  higher  level  of  civili- 
zation than  can  nations  which  wall  them- 
selves about  with  a  great  physical  barrier 
as  did  China.  Nations  which  prop  them- 
selves up  through  a  small  governing  class 
with  barriers  to  free  action,  leaving  the 
sinews  of  their  character  to  shrivel  and 
decay,  finally  lose  the  knack  of  self -protec- 
tion and  real  progress. 


CHAPTER  V 

THE  PREVENTION  OF  SEXUAL 
INFECTIONS 

A  cooperative  effort  which  ^ill  embrace 
society  from  top  to  bottom, — that  is  what 
the  Prevention  of  Sexual  Infections  im- 
plies. 

The  employment  of  any  single  measure 
cannot  be  relied  upon  to  accomplish  the 
purpose.  No  groups  of  measures,  no  suc- 
cession of  steps,  no  system,  no  matter  how 
msely  evolved  or  skillfully  launched,  can 
hope  for  any  success  unless  the  plan  is 
approved  of  by  a  sympathetic  public  and 
carried  forward  with  real  sincerity. 

No  good  purpose  will  be  gained  by  dis- 
guising the  fact  that  the  road  ahead  is  a 
long  one.  Neither  need  we  try  to  hide 
from  ourselves  the  fact  that  the  road  mil 
have  to  be  much  cleared  before  we   can 

44 


PREVENTION  OF  SEXUAL  INFECTIONS       45 

make  any  material  progress.  In  other 
words,  it  ^\ill  be  quite  useless  to  bring  new 
measures  into  play  and  expect  to  see  them 
operate  successfully  while  the  underlying 
causes  of  our  present  difficulty  still  flourish. 
^^  Remove  the  cause  and  the  patient  will 
get  well,"  is  as  true  of  society  as  it  is  of 
the  single  individual.  Then  the  methods 
which  are  instituted  for  the  prevention  of 
these  diseases  will  probably  carry  their 
own  weight  of  usefulness;  at  the  present 
time  this  is  not  the  case.  The  necessary 
measures  for  the  removal  of  the  difficulties 
in  our  way  are,  for  the  most  part,  obvious ; 
it  is  the  purpose  of  this  book  to  try  and 
point  out  the  more  important  ones. 

In  the  short  chapter  dealing  with  the 
role  of  alcohol  it  was  made  quite  plain  that 
its  unintelligent  use  constitutes  perhaps  the 
greatest  danger  to  society,  in  not  only  un- 
dermining the  germinal  cells  at  conception 
but  as  a  most  fertile  cause  of  transmitting 
and  complicating  sexual  diseases.  It  is 
plain  then  that  a  quality  of  character  will 
have  to  be  cultivated  which  can  resist  the 
unwise  use  of  alcohol.     Especially  is  this 


46  CONTROL  OF  SEX  INFECTIONS 

SO  in  the  United  States  at  present,  where 
in  certain  districts  and  among  certain  peo- 
ple the  repressive  measures  of  law  tend 
to  increase  its  consumption  and  decrease 
its  quality. 

The  lack  of  human  consideration  in  our 
present  industrial  and  commercial  life  may 
be  laid  alongside  of  alcohol ;  and  these  twin 
evils  may  be  looked  upon  as  perhaps  the 
two  most  vital  factors  in  the  corruption  of 
society  in  which  sexual  infection  and  racial 
degeneration  are  running  a  close  race.  If 
we  are  going  to  clear  the  way  and  set  in 
motion  means  aimed  to  do  away  with  de- 
generation and  sexual  disease,  a  little 
further  study  of  what  has  been  termed 
*^the  lack  of  human  consideration"  is  nec- 
essary. It  might  also  be  spoken  of  in  a 
broad  sense  as  development  without  reflec- 
tion, for  we  have  developed  a  system  which 
has  snared  the  captor  as  well  as  the  captive. 
By  the  greedy  efforts  of  many  captains  of 
industry  ^^big  business"  has  been  accom- 
plished, but  the  human  factor  in  combing 
the  globe  for  wage-workers  has  been  rue- 
fully neglected.     So  that  we  have  in  one 


PREVENTION  OF  SEXUAL  INFECTIONS       47 

half  of  a  composite  picture  the  over-rich 
with  their  sated  families  and  satellites  suf- 
fering from  excesses  and  idleness,  hunting 
fresh  food  for  their  Vanity  while  trying  to 
wrest  some  satisfaction  from  the  display 
of  costly  surroundings  or  some  degree  of 
public  approval  from  their  check-book 
charities.  In  the  other  half  of  the  picture 
we  see  the  great  masses  of  industrial  work- 
ers which  have  been  rooted  up  from  a 
wholesome  rural  environment  and  herded 
into  physically  unfitting,  sex  provoking,  ex- 
citing and  character  destroying  proximity, 
with  practically  all  individuality  extin- 
guished; held  by  the  lure  of  an  easier  life 
and  busy  making  the  poorest  goods  for  the 
greatest  prices. 

These  things,  it  will  be  found,  will  be 
real  stumbling  blocks  in  the  way  of  such 
measures  for  the  prevention  of  sexual  in- 
fections as  we  may  have  to  propose.  On 
the  other  hand  the  chapter  on  what  every 
boy  and  girl  should  be  taught,  and  the 
chapter  on  universal  training  will  deal  with 
methods  by  which  it  is  possible  to  accom- 
plish a  very  great  deal  against  these  two 


48  CONTROL  OF  SEX  INFECTIONS 

great  social  evils — alcohol  and  industrial- 
ism. 

Not  to  be  neglected  as  a  fruitful  source 
of  sexual  infection  is  prostitution,  but  to 
fasten  our  whole  attention  on  getting  rid 
of  prostitution,  even  if  that  were  immedi- 
ately possible,  would  as  a  means  of  getting 
rid  of  these  diseases  carry  us  but  a  frac- 
tional part  of  the  way.  Though  we  may 
look  upon  prostitution  as  an  unmitigated 
and  degenerating  evil  in  every  form  in 
which  it  appears,  the  act  of  doing  away 
mth  every  individual  prostitute  in  exist- 
ence would  not  cure  prostitution;  and  the 
reason  for  this  is  simple,  as  the  constant 
demand  for  them  is  almost  entirely  made 
by  men;  the  number  of  women  who  are 
prostitutes  of  their  own  volition  being 
comparatively  small.  The  stupid  steps 
which  society  takes  in  hounding  these  poor 
creatures  whom  society  has  itself  created, 
while  at  the  same  time  the  male  members 
of  society  who  demand  and  support  them 
are  never  reproached,  mil  furnish  interest- 
ing matter  for  thoughtful  study  for  those 
who  can  think  on  a  higher  level  than  that 


PREVENTION  OF  SEXUAL  INFECTIONS       49 

on  which  our  police-regulation  thinking  is 
done. 

It  is  not  the  object  of  this  book  to  go 
into  the  history  of  prostitution  or  to  de- 
scribe the  methods  employed  in  the  creation 
of  this  ancient  profession  in  its  various 
forms.  All  this  has  been  amply  written 
upon,  from  the  favored  mistress  of  the 
rich  man  down  to  the  forlorn  specimens 
of  commercialized  vice  who  are  virtually 
bought  and  sold.  What  concerns  us  here 
is  the  care  and  control  of  sexual  infections 
and  to  that  end  our  sentiments  regarding 
these  unfortunate  condition-made  women 
should  be  radically  reformed  and  our  atti- 
tude toward  them  humanely  altered  if  we 
hope  to  erase  the  sources  of  infection  which 
they  represent,  and  to  circumvent  the  evil 
of  prostitution  itself;  but  this  will  require 
patience,  wisdom,  and  a  broad  human  un- 
derstanding. 

Morally  speaking,  the  border  line  of 
prostitution  is  often  obscure  and  difficult 
to  detect,  as  women  who  prostitute  them- 
selves in  marriage  for  money,  or  childless 
luxury,    will    attest;    these    circumstances 


50  CONTEOL  OF  SEX  INFECTIONS 

have  earned  the  title  of  ^^fashionable  pros- 
titution." The  distinction  is  further  con- 
fused by  the  present-day  large  class  of 
purely  pleasure-seeking  girls  and  women 
who  shrink  from  household  tasks  which 
give  the  essential  physical  and  educational 
preparation  for  matrimony  and  maternity ; 
and  with  powder  and  paint  taking  the  place 
of  the  natural  bloom  of  health  and  purpose 
these  idle  imitations  of  the  female  sex  are 
everywhere  in  evidence,  making  their  ap- 
peal to  the  baser  side  of  men's  nature. 
If  the  woman  is  to  fulfill  nature's  require- 
ments of  her,  it  is  just  as  essential  for  her 
to  have  muscular  work  to  do  as  it  is  for 
the  man.  Every  nation  which  fails  to  ap- 
preciate this  necessity  must  end  in  extinc- 
tion. The  woman  should  develop  bodily 
strength  and  health  so  that  she  may  have 
strong,  robust  and  intelligent  children, 
and  the  genuine  woman's  ideal  should 
point  to  nothing  less  than  this. 

One  of  the  greatest  obstacles  to  our  in- 
stituting measures  of  prevention  of  sexual 
diseases  will  be  found  in  the  false  modesty 
which  prevents  open  discussion  of  these 


PREVENTION  OF  SEXUAL  INFECTIONS       51 

diseases ;  the  groundless  traditional  terror 
that  has  kept  this  whole  subject  locked  up 
in  the  dark.  This  it  will  be  necessary  to 
overcome  and  this  we  shall  find  is  possible 
to  overcome  when  a  sincere  interest  is 
awakened  and  sincere  efforts  are  being 
made  in  the  practical  work  ahead  in  which 
all  must  take  some  part.  Let  us  go  on 
then  to  the  discussion  of  practical  meas- 
ures which  can  be  employed.  First  and 
foremost  is  governmental  sanction  and  ac- 
tivity. This  is  already  assured,  and  in 
proportion  to  the  ability  and  sincerity  of 
the  leaders  and  the  backing  of  congres- 
sional appropriations  will  its  progress  be 
marked.  It  has  begun  its  work  with  edu- 
cational posters  and  literature  and  with  a 
number  of  public  clinics  for  the  treatment 
of  these  diseases.  Many  of  the  States 
have  formulated  campaigns  and  some  are 
fitting  in  their  efforts  with  those  of  the 
United  States  Public  Health  Service.  All 
this  has  a  promising  trend,  but  without  the 
live  sympathy  of  the  public,  and  more, 
without  an  insisting  public  demand  for  re- 
sults, these  brave  beginnings  will  be  very 


52  CONTROL  OF  SEX  INFECTIONS 

apt  to  simmer  down  to  meaningless  forms. 
It  will  be  the  part  especially  of  all  physi- 
cians, social  workers,  religious  and  lay 
teachers  and  parents  to  keep  abreast, 
through  their  departments  of  health,  of 
this  public  service  and  see  that  it  functions 
to  the  full  need  of  their  community.  The 
appalling  exposure  of  our  social  status 
through  war-made  records  leaves  nothing 
less  than  this  in  the  way  of  personal  re- 
sponsibility. 

What  a  city  or  a  state  department  of 
health  stands  for  in  relation  to  the  citizen 
should  be  better  and  more  generally  appre- 
ciated by  every  citizen.  It  is  really  not  a 
prison  to  which  burly  police  officers  hurry 
otf  their  victims  to  be  vaccinated  or  vapor- 
ized according  to  the  dyspeptic  disposition 
or  decision  of  a  doting  judge;  quite  the 
contrary,  it  is  the  individuaPs  best  public 
friend.  It  is  the  citizens^  health  club,  so 
to  speak,  set  up  to  ensure  and  protect  the 
good  health  and  therefore  the  greatest 
happiness  of  each  and  all  of  us ;  and  it  is  in 
this  light  we  should  come  to  think  of  it, 
to  encourage  it  and  to  make  use  of  it. 


PREVENTION  OF  SEXUAL  INFECTIONS       53 

The  press  is  capable  of  a  vast  educa- 
tional assistance  in  publishing  authorita- 
tive information  regarding  the  progress  of 
public  health  work  in  this  field  of  vital 
public  health  interest.  Too  serious  is  this 
matter  to  be  left  festering  in  the  dark  any 
longer.  Our  children  have  a  right  to  a  dif- 
ferent policy  than  has  marked  our  past  per- 
formance in  the  matter  of  sexual  sickness 
which  has  snatched  the  blessings  of  whole 
sight  or  clean  bodies  from  so  many  of 
them. 

There  are  certain  measures  which  every 
department  of  health  should  carry  out,  and 
be  fortified  in  (where  that  has  not  already 
been  done)  by  legal  enactment.  First,  the 
reporting  of  all  cases  of  Gonococcus  In- 
fection, of  Syphilis  and  of  Chancroid  to 
the  Board  of  Health.  This  matter  should 
not  be  shirked.  These  diseases  should  be 
reported  under  the  name  (not  initials  or 
number)  of  the  patient.  At  the  present 
stage  of  our  social  morality  these  patients 
should  not  be  made  to  feel  more  guilty  of 
disgrace  than  the  guiltiness  of  the  society 
which  has  through  its  neglect  suffered  such 


54  COXTROL  OF  SEX  INFECTIONS 

diseases  to  be  rampant.  That  these  dis- 
eases should  be  treated  by  any  but  author- 
ized physicians,  should  be  illegal.  All 
cases  of  Gronorrhea  and  Syphilis  should  be 
followed  through  their  treatment  by  a 
record.  The  United  States  Army  form  of 
Syphilitic  Register  should  be  adopted,  and 
a  similar  register  had  for  Gonorrhea. 
The  entire  treatment  should  be  recorded 
until  a  clean  bill  of  health  is  obtained  and 
freedom  from  infectiousness  is  determined 
by  expert  opinion.  The  completed  Regis- 
ters should  be  filed  mth  the  Department 
of  Health.  No  certificate  of  marriage 
should  be  issued  without  a  certainty  ex- 
isting that  there  is  no  sexual  infection 
present. 

The  act  of  infecting  another  with  a  Sex- 
ual Infection  through  sexual  intercourse 
should  be  a  crime  inevitably  followed  by 
heaw  punishment,  and  with  damages  for 
the  infected  individual.  This  is  the  most 
important  legal  measure  to  be  enacted  in 
relation  to  these  diseases. 

The  crime  of  conveying  Syphilis  or 
Gonococcus     Infection- — especially     as     a 


PREVENTION  OF  SEXUAL  INFECTIONS       55 

wedding  gift — is  comparable  with  murder, 
in  that  it  is  capable  of  destroying  both 
health  and  happiness,  without  which  life  is 
worthless. 

The  question  of  medical  prophylaxis 
being  pursued  in  civil  life  seems  to  have 
become  a  debatable  subject.  The  argu- 
ment will  follow  its  description. 

Medical  prophylaxis  as  at  present  em- 
ployed by  the  army,  consists  of  an  equip- 
ment comprising  the  essentials  for  the  fol- 
lowing treatment  prescribed  to  be  carried 
out  as  soon  as  possible  after  exposure  to 
disease: — Washing  the  genital  organs  and 
surrounding  parts  with  soap  and  water 
after  the  bladder  has  been  emptied; 
swabbing  the  washed  area  with  a  1  to  1000 
or  1  to  2000  solution  of  bichloride  of  mer- 
cury; a  urethral  injection  of  a  one  or 
two  per  cent,  solution  of  portargol;  rub- 
bing into  the  genital  and  surrounding  parts 
calomel  ointment,  thirty  per  cent. 

If  this  procedure  of  prophylaxis  is 
promptly  and  properly  carried  out  the  lia- 
bility of  infection  should  be  practically  nil. 
The  antiseptic  property  of  soap  and  water 


56  CONTROL  OF  SEX  INFECTIONS 

alone,  if  immediately  and  carefully  nsed, 
and  the  urethra  having  been  flushed  by 
urination,  mil  in  most  cases  be  protective. 

The  regular  army  medical  ofi&cers,  who 
have  had  by  many  years  the  fullest  experi- 
ence in  prophylaxis,  showed  by  their  great 
interest  in  this  form  of  preventive  treat- 
ment their  confidence  in  its  e:ffectiveness. 
There  is  no  lack  of  evidence  given  in  army 
literature  as  to  the  protective  value  of  this 
affair  if  it  is  done  soon  enough  after  an 
exposure  to  disease.  It  is  most  effective  if 
performed  mthin  one  hour;  but  even  if 
done  after  three  or  four  hours  it  should 
protect  the  great  majority  of  cases. 

Another  form  of  prophylaxis  has  been 
employed,  consisting  of  the  essentials  in  a 
small  packet  which  can  be  carried  in  the 
pocket  and  which  gives  the  theoretical  ad- 
vantage of  prompt  employment ;  and  which 
would  be  an  actual  advantage  if  used 
properly  and  promptly,  which  it  rarely 
ever  is.  The  essence  of  the  whole  pro- 
cedure is  simply  an  evacuation  of  the 
bladder,  a  soap  and  water  washing  followed 
by  antiseptic  applications. 


PREVENTION  OF  SEXUAL  INFECTIONS       57 

The  argument  seems  to  be :  Can  we  ad- 
vocate a  plan  of  personal  protection  which 
tacitly  sanctions  prostitution?  The  an- 
swer to  that  argument  is  that,  if  rightly 
employed,  it  can  be  made  a  powerful  dis- 
couragement to  prostitution,  besides  being 
a  public  health  measure  of  the  widest  im- 
portance. 

Only  that  form  of  prophylaxis  which  is 
given  in  a  properly  equipped  and  responsi- 
ble station  under  the  auspices  of  the  Health 
Department  should  be  advocated.  The 
personally  administered  pocket  variety  is 
not  to  be  recommended. 

It  is  possible  to  make  a  prophylaxis  sta- 
tion a  social  influence  of  peculiar  force. 
From  a  mature,  conscientious,  high-class 
man  in  attendance  the  applicant  can  learn 
the  dangers  and  disadvantages  which  at- 
tend prostitution.  He  can  learn  something 
of  the  general  disaster  following  in  the 
train  of  sexual  infections,  and  the  great 
burden  of  cost  which  it  involves.  Without 
preaching  morality  to  him  he  will  see  the 
sense  of  the  campaign  against  these  dis- 
eases and  perhaps  become  a  disciple  of  the 


58       CONTROL  OF  SEX  INFECTIONS 

cause.  Such  stations  should  be  kept  as 
clean  and  orderly  as  an  operating  room 
should  be  kept,  a  lesson  in  cleanliness  and 
order  mil  thus  be  conveyed  and  results  will 
be  enhanced.  Eecords  should  be  kept  of 
the  time  of  exposure  to  disease  and  time  of 
treatment.  If  more  than  three  hours  has 
elapsed  since  exposure  the  patient  should 
return  for  observation  every  other  day  for 
a  week,  and  then  once  a  week  for  a  month 
so  that  he  can  obtain  the  benefit  of  the 
earliest  possible  treatment  in  the  event  of 
the  development  of  disease. 

Probably  one  station  of  two  or  three 
treatment  rooms  would  be  sufficient  in 
every  twenty-five  thousand  of  inhabitants. 
It  is  best  to  have  them  in  hospitals  when 
that  is  feasible.  It  mil  be  impossible  to 
compel  the  use  of  these  stations  in  civil 
life  as  it  was  in  the  army;  but  the  army 
and  navy  having  taught  the  advantages  of 
prophylaxis  to  several  million  men,  their 
economic  advantage  will  soon  come  to  be 
common  knowledge.  That  methods  of  this 
sort  should  have  to  be  thought  of  at  all 
is  rather  more  a  stain  on  our  citizenship 


PREVENTION  OF  SEXUAL  INFECTIONS       59 

and  religion  than  a  reflection  on  the  means 
necessary  to  improve  them.  They  will 
automatically  go  out  of  existence  when  so- 
ciety has  washed  its  dirty  linen,  if  it  ever 
can. 

Our  educational  opportunities  in  the  pre- 
vention of  sexual  infections  will  be  spe- 
cifically dealt  with  in  the  succeeding  two 
chapters. 

The  U.  S.  Army  demonstrated  a  value 
in  social  measures  to  diminish  sexual  temp- 
tation, or  more  strictly  speaking  the  army 
gave  its  approval  to  religious  and  other  or- 
ganizations to  station  themselves  in  and 
about  army  camps  in  order  to  entertain 
and  enliven  the  soldiers  by  a  higher  minded 
form  of  amusement  and  companionship 
than  the  soldiers  were  likely  to  find  for 
themselves.  There  can  be  no  doubt  that 
this  plan  saved  from  sexual  infections 
many  men  who  otherwise  would  have  found 
companions  whose  acquaintance  would 
have  undoubtedly  resulted  in  disease. 

In  connection  with  loneliness  and  sexual 
disease  very  interesting  studies  were  made 
of  this  in  England  VN^here   infection  was 


60      CONTROL  OF  SEX  INFECTIONS 

found  to  be  so  much  more  frequent  among 
territorials  on  leave  than  among  English 
Tommies  on  leave  who  had  families  and 
friends  for  companionship. 

So  it  is  we  see  the  underlying  causes  of 
the  sexual  infections — the  factors  which 
furnish  the  soil  and  nourishment  for  these 
insidious  weeds  of  society,  the  roots  of 
which  delve  so  deep  below  the  surface. 
And  so  it  is  that  we  must  see  that  the  re- 
sponsibility for  these  diseases  rests  on  a 
society  wliich,  clothed  in  an  ostensible 
righteousness,  hurries  by  indifferent  to  the 
cost  of  health  and  happiness  which  lies  so 
largely  in  its  hands  to  prevent. 

Thus  it  becomes  necessary  to  turn  to  the 
task  of  social  readjustment  and  mend  the 
evils  that  an  industrial  haste  and  alcohol 
and  promiscuous  sexuality  have  so  firmly 
planted,  before  the  sound  sanitary  meas- 
ures of  prevention,  which  we  have  at  hand, 
can  justify  their  usefulness. 


CHAPTEE  VI 

WHAT  EVERY  BOY  AND  GIRL 
SHOULD  BE  TAUGHT 

Here  is  the  site  upon  which  the  store- 
house of  human  knowledge  must  find  its 
foundation — the  child  mind — if  a  clear  view 
of  life  for  the  individual  is  to  be  had. 

The  most  important  mind  impression  pe- 
riod is  up  to  eight  or  ten  years  of  age. 
Or  as  a  noted  educator  once  said,  "a 
child's  education  begins  when  it  is  born 
and  ends  when  it  goes  to  school.'' 

One  might  say  the  first  impressions  con- 
stitute the  fibres  from  which  the  mental 
processes  weave  their  fabric  later  on;  so 
that  in  life  each  mind  is  clothed  in  coarse 
or  cultured  dress. 

Two  periods  of  sexual  instruction  in 
youth  are  essential:  the  first  before  the 
child  is  conscious  of  sex ;  the  second  as  sex 
awakens. 

61 


62  COXTROL  OF  SEX  INFECTIONS 

The  first  or  early  impressions  should 
forestall  the  child's  curiosity  as  to  the  birth 
of  things,  or  be  at  about  the  same  time  that 
this  curiosity  asserts  itself.  What  the 
childish  mind  is  anxious  to  settle  is  where 
the  kittens  came  from  which  seems  of  a 
sudden  to  occupy  the  attention  of  the  house- 
hold cat.  Of  impregnation  the  little  head 
is  not  at  all  concerned. 

But  it  is  not  necessary  to  await  the  cat's 
accouchement  before  the  first  lessons  are 
installed.  As  soon  as  the  child  can  take  in 
the  fact  that  from  day  to  day  the  plant 
grows,  the  buds  appear  and  then  open  into 
flowers,  it  should  be  led  to  this  observation. 
The  subject  then  of  food  upon  which  the 
plant  grows  can  be  made  a  lesson.  Thus 
is  the  child  mind  gently  opened  to  the  ways 
of  nature.  But  that  a  neiv  plant  may  grow 
— this  wonder  is  performed  before  its 
eyes — a  seed  is  planted  in  the  earth,  and 
presently  the  little  plant  is  bom.  The 
lesson  of  impregnation,  as  the  child's  mind 
will  later  come  to  learn  its  ways  in  the  life 
of  fishes  or  birds  or  animals,  is  almost  ac- 
complished. 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         63 

From  the  seeds  that  gave  forth  a  new 
plant  the  small  mind  can  be  directed  to  the 
egg  which  gives  forth  a  new  life.  How  the 
egg  is  born  from  the' hen  is  then  made  clear, 
and  how  the  egg  has  grown  up  inside  the 
hen  mitil  it  is  big  enough  to  be  bom  or 
laid  is  explained. 

This  teaching  may  well  be  aided  by  pic- 
tures or  diagrams. 

When  the  child  has  grasped  these  simple 
facts  of  nature  it  holds  a  skeleton  key  as  it 
were  to  practically  all  the  rest.  By  this 
time  the  family  cat  may  be  almost  ready  to 
be  delivered.  The  child's  attention  is  di- 
rected to  her  increased  size,  and  to  the 
child's  little  mind  is  recalled  the  hen's  ex- 
perience of  keeping  the  egg  before  it  is 
ready  to  be  ^^born. "  When  the  kittens 
make  their  appearance  then  there  should 
be  no  undue  surprise.  And  so  the  way 
opens  for  larger  things. 

These  details  have  not  been  set  down  to 
show  just  what  is  necessarily  the  best  se- 
quence of  natural  events  for  purposes  of 
child  instruction.  They  have  been  thus  set 
down  to  illustrate  the  child's  mental  capac- 


64  CONTROL  OF  SEX  INFECTIONS 

ity,  and  with  what  tact  and  gentleness  the 
small  mind  must  be  initiated  into  the 
corner  stone  truths  upon  which  the  whole 
sexual  structure  is  later  on  to  be  built. 

They  have  also  thus  been  given  to  show 
how  impersonally,  how  little  hindered  by 
the  confusion  of  self-consciousness  sex 
matters  can  be  approached,  and  the  impor- 
tant sexual  truths  can  be  calmly  thought 
of  and  transmitted.  This  is  the  important 
thing  just  now  for  until  one  generation  has 
thus  been  justly  instructed  we  cannot  hope 
that  parents  mil  reflexly  repeat  to  their 
progeny  this  vital  knowledge. 

Thus  then  must  this  first  period  of  sex 
teaching  be  carried  on  long  before  the  sex- 
ual life  of  the  child  awakens  into  conscious- 
ness of  self. 

From  the  more  obvious  events  which  at- 
tend the  reproductive  processes  of  animals, 
that  is,  the  mother  carrying  her  young  and 
then  putting  them  forth  into  the  world,  the 
child  can  be  given  some  idea  of  how  (let 
us  keep  in  mind  the  household  cat  to  illus- 
trate) these  kittens  grow  and  are  nourished 
by  the  mother  while  she  is  carrying  them 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         65 

and  until  they  are  big  enough  to  look  out 
for  themselves  and  be  fed  by  their 
mother's  milk  after  they  are  born. 

Then  to  go  deepe'r  into  the  subject  of 
origin  the  child  can  be  told  how  it  is  neces- 
sary for  the  production  of  these  kittens  to 
have  a  father  as  well  as  a  mother,  for  it 
is  the  father  which  has  the  seeds  of  kittens 
which  he  must  give  to  the  mother  before 
the  kittens  can  start  to  grow  up  inside  of 
her  very  much  as  the  seed  must  be  planted 
in  the  earth  before  the  earth  will  produce 
the  small  plant  as  the  child  earlier  ob- 
served. 

From  this  point  of  understanding  it  will 
not  be  difficult  to  bring  the  child  to  see  that 
human  beings  are  to  all  intents  and  pur- 
poses like  animals  in  the  way  they  have  to 
carry  their  young  inside  of  them  until  the 
baby  is  ready  and  big  enough  to  be  born. 
All  of  which  can  be  made  clear  by  pictures. 

This  theme  can  be  pursued  into  the  realm 
of  mother  love  and  tender  care  of  the  child 
until  it  grows  up ;  and  then,  after  the  child 
has  become  either  a  man  or  woman  its  turn 
to  parenthood  will  come  with  its  opportun- 


66      CONTROL  OF  SEX  INFECTIONS 

ity  to  have  fine  healthy  children  to  care 
for  and  love. 

Nothing  bnt  the  truth  concerning  the 
processes  of  reproduction  should  be  told 
to  the  child.  Why  should  we  ever  be  em- 
barrassed or  hesitate  to  make  clear  to  our 
own  children  the  most  beautiful  and  most 
w^onderful  of  all  natural  phenomena? 
The  answer  is  simple;  because  we  did  not 
learn  these  things  as  wonderful  or  beauti- 
ful ourselves,  or  because  we  are  afraid  our 
children  will  discover  what  is  in  our  minds 
instead. 

If  all  teachers  and  parents  can  feel  and 
keep  this  one  f  ollo^\ing  central  truth  clearly 
in  mind,  most  of  the  difficulty  of  teaching 
how  nature  multiplies  will  be  forever  re- 
moved. Nature's  sole  concern  is  that  we 
do  multiply.  The  small  matter  of  our  fool- 
ish self-consciousness  is  of  small  moment 
to  Nature  in  her  larger  task  of  keeping  up 
the  race. 

If  we  are  bound  on  Nature's  errand  in 
life  there  will  be  no  occasion  for  shame  in 
the  discussion  of  sexual  matters  \vith  any- 
one. 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         67 

It  is  not  to  be  understood  that  this  teach- 
ing of  reproduction  is  to  constitute  the  sole 
instruction  of  this  period  of  childhood;  but 
it  can  be  taken  to  m^an  that  this  early  ob- 
servation and  simple  nature  study  com- 
prises the  most  important  elements  of  be- 
ginning knowledge.  Not  only  is  this  so 
from  the  standpoint  of  necessary  informa- 
tion, but  because  in  the  young  mind  facts 
have  been  deduced  from  observation,  which 
power  has  exercised  and  actually  set  into 
motion  that  most  essential  function  of  the 
brain — independent  thought  from  personal 
observation. 

It  has  been  contended  in  writings  on  so- 
cial hygiene  that  to  teach  one  child  the 
truth  about  these  matters  of  reproduction 
and  then  allow  that  child  the  companion- 
ship of  other  children  neglected  in  this  re- 
spect and  provided  only  with  the  fabrica- 
tions of  indifferent  parents  who  will  not  be 
bothered  to  satisfy  that  natural  childish 
curiosity  which  is  forever  putting  out  in- 
quiry as  its  small  mind  gropes  after  infor- 
mation, will  result  in  a  negation  of  that 
teaching  by  the  group  opinions  of  its  fel- 


68      CONTROL  OF  SEX  INFECTIONS 

lows  falsely  led.  Let  us  not  be  concerned 
on  this  score  for  it  is  far  more  likely  that 
the  single  seed  of  trnth  fortified  by  the 
familiarity  of  personal  observation  will 
hold  its  own  against  the  babel  of  unbacked 
belief  and,  what  is  more,  may  bring  about 
conversion  unawares. 

It  is  safe  to  say  that  in  the  case  where 
nature's  plan  of  reproduction  is  clearly 
put,  before  the  child  is  conscious  of  its 
sex,  that  when  that  sex  awakes  nature's 
purpose  will  be  plain.  Added  to  this  it  is 
also  safe  to  say  that  in  the  case  of  normal 
children  growing  up  there  is  much  less 
likelihood  of  sexual  perversions  finding  a 
foothold. 

But  how  is  this  teaching  to  be  brought 
about?  It  is  true,  that  unless  such  instruc- 
tion and  guidance  can  be  put  on  a  basis 
of  universal  teaching  we  shall  be  very  far 
from  accomplishing  our  object.  Unless  the 
present  plan  of  subterfuge  and  sham  can 
be  replaced  by  truth  and  an  actual  effort 
toward  enlightenment  by  longer  strides 
than  we  are  making  in  that  direction  now, 
the  ground-work  for  preventive  measures 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         69 

aimed  at  the  sexual  infections  will  surely 
fail. 

There  seems  to  be  no  division  of  opinion 
among  the  thoughtful  and  well  educated 
people  of  the  present  day  that  it  is  the 
child's  right  to  be  thus  instructed.  Neither 
does  there  seem  to  be  any  doubt  as  to  the 
parents'  obligation  in  this  matter.  But 
how  is  it  to  be  brought  about?  Both 
danger  and  difficulty  seemingly  lie  ahead. 
Without  some  knowledge  of  anatomy  and 
physiology,  without  some  comprehension  of 
sexual  psychology,  without  a  little  inkling 
of  botany,  even  these  simple  first  period 
lessons  on  the  essential  beginnings  of  life 
will  be  far  from  perfect;  and  the  second 
period  of  instruction  at  the  oncoming  of 
puberty  will  be  valueless. 

With  the  hasty  survey  that  so  many  of 
these  problems  get  before  they  are  dis- 
carded as  out  of  the  question,  this  problem 
could  easily  suffer  the  same  eclipse.  But 
we  shall  not  allow  it  to  escape  us  so  easily 
as  that.  Of  course  the  average  parent  is 
quite  ignorant  of  the  scientific  facts  in  the 
case,  and  almost  equally  uninformed  are 


70  CONTROL  OF  SEX  INFECTIONS 

our  institutional  teachers.  Physicians 
likewise  though  they  may  know  the  scien- 
tific side  are  inexperienced  in  the  way  this 
matter  should  be  set  forth;  they  have 
neither  the  teacher's  art  of  teaching  nor 
the  natural  parent's  deep  concern  of  its 
child's  welfare;  but  the  sum  of  what  the 
three  (parent,  teacher,  and  physician)  pos- 
sess, however,  is  equal  to  the  occasion.  If 
we  have  the  courage  of  our  conviction,  that 
it  is  the  child's  right  to  receive  protective 
knowledge  against  disease,  disgrace  and  de- 
generation, then  let  us  see  in  what  way 
we  can  best  provide  that  necessary  instruc- 
tion. What  is  needed  for  the  first  period 
of  the  child's  sex  character  structure? 

First,  a  good  example  set  by  the  parents 
in  a  cheerful  and  sanitary  home. 

Here  already  much  is  being  accom- 
plished toward  this  by  the  splendid  work 
of  '^community  centers"  and  social  work- 
ers. Then  should  come  some  such  plan  of 
child  instruction  as  I  have  already  out- 
lined. Parents  must  be  instructed  in  this, 
and  teachers  provided  by  the  local  Health 
Departments    could  be   easily   trained   to 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         71 

teach  the  mothers  the  simple  steps  of  this 
early  instruction.  Practically  no  scientific 
knowledge  would  be  necessary  beyond  the 
explanations  which  'would  go  with  a  few 
pictures  and  diagrams  illustrating  the 
plant  study  and  anatomical  cuts  with  which 
to  make  clear  the  reproductive  processes 
of  chickens,  domestic  animals  and  the 
human  plan  of  carrying  the  baby  before  it 
is  born.  The  act  of  copulation  need  in 
the  child's  mind  be  no  more  than  the  act 
of  planting  the  seed,  which  is  all  that  it  is 
in  the  mind  of  Nature,  so  to  speak.  The 
sexual  appetite  or  desire  which  imperiously 
demands  the  male  of  the  species  to  carry 
out  his  part  in  the  laws  of  reproduction  by 
depositing  the  fertilizing  sperm  in  the 
body  of  the  female,  does  not  concern  this 
phase  of  the  child's  instruction,  and  right- 
fully belongs  to  the  second  period  when  the 
sexual  feelings  of  the  boy  or  girl  are  as- 
serting themselves,  and  when  explanations 
of  these  natural  phenomena  will  be  un- 
derstood, and  their  high  purposes  appre- 
ciated. 

The  normal  child  before  it  is  seven  or 


72  CONTROL  OF  SEX  INFECTIONS 

eight  should  be  able  to  take  in  these  simple 
but  right  guiding  lessons. 

The  tremendous  value  of  satisfying  the 
normal  child's  curiosity  with  a  correct  un- 
derstanding of  these  matters  would  be  hard 
to  measure.  All  the  vain  searching  after 
some  reasonable  explanation  of  these  phe- 
nomena would  be  at  an  end.  All  the  foul 
smirching  of  the  little  soul  would  possess 
its  antidote  of  truth.  All  the  energy  lost 
by  the  searching  and  smirching  would  be 
saved  for  something  else.  A  profound  re- 
spect for  these  wonderful  processes  of  na- 
ture, a  wholesome  interest  in  all  her  ways 
and  a  beginning  sense  of  its  duty  to  human- 
ity would  be  the  nebulous  sentiments  form- 
ing in  the  child's  brain.  Need  we  ask:  Is 
it  worth  while? 

Now  for  a  period  of  years  specific  sex 
instruction  should  be  omitted.  The  knotty 
problems  of  the  child  have  been  solved. 
A  confidence  has  been  established  between 
mother  and  child  which  will  make  the  sub- 
ject easy  of  approach  if  the  young  boy  or 
girl  needs  new  enlightenment. 

Parents  and  teachers  can  turn  to  the  task 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         73 

of  building  up  character  and  training  the 
child's  will,  of  developing  its  body  and 
storing  its  mind. 

When  the  second  period  of  sexual  teach- 
ing comes  it  will  require  a  very  different 
treatment.  It  will  be  the  obligation  of  the 
parents  to  keep  on  the  lookout  for  the  ap- 
proach of  puberty.  The  boy  now  should 
be  the  special  object  of  the  father's  obser- 
vations and  the  mother  should  watch  for 
the  girl's  oncoming  sexual  life. 

At  this  time  the  father  should  tell  the 
boy  that  seminal  overflow  or  emissions  are 
to  be  expected  and  that  this  is  altogether 
a  natural  thing.  The  mother  should  ex- 
plain to  the  girl  what  menstruation  is,  and 
how  it  is  likely  to  act.  But  further  teach- 
ing than  this,  at  this  time  of  popular  igno- 
rance of  sex  anatomy  and  physiology, 
should  be  carried  on  by  the  teacher  quali- 
fied and  trained  for  this  work.  It  should 
be  a  part  of  all  school  training.  Already 
it  has  been  started  here  and  there,  but  that 
is  not  enough.  A  well  thought  out  and  sys- 
tematically taught  course  in  the  anatomy 
and  physiology  of  sex,  with  some  instruc- 


74  CONTROL  OF  SEX  INFECTIONS 

tion  on  the  sexual  infections  and  other 
pathology,  should  be  made  available  to 
every  boy  and  girl  reaching  puberty.  As 
mentioned  before,  it  should  be  the  parents ' 
care  to  know  when  the  boy  or  girl  is  ready 
for  this  instruction  and  then  enter  them  in 
the  class.  This  should  not  be  all:  the 
school  should  also  check  up  the  parents' 
part  so  that  no  pupil  is  omitted. 

To  start  with,  these  teachers  should  be 
physicians  until  the  teaching  has  reached 
a  satisfactory  standard,  when  it  may  pos- 
sibly be  passed  into  the  hands  of  conscien- 
tious lay  teachers  specially  fitted  for  the 
work. 

The  advent  of  the  moving  picture  has 
made  much  possible  in  this  field  which 
would  have  been  very  difficult  clearly  to 
teach  without  this  aid. 

There  should  be  one  course  of  instruction 
planned  to  meet  the  needs  of  the  boys,  and 
another  for  the  girls. 

Besides  making  plain  the  mechanics  so  to 
speak  of  reproduction  the  sentiments  of 
sexual  life  should  be  dealt  with.  Here  it 
is  that  a  great  good  may  be  accomplished 


BOY  AND  GIRL  SHOULD  BE  TAUGHT         75 

by  setting  the  standards  of  sexual  affinity 
and  faithfulness  on  the  high  plane  which 
should  be  their  eternal  place  in  the  minds 
of  men  and  women.  'The  sexual  life  should 
be  raised  up  from  the  low  estate  to  which 
it  has  unhappily  fallen  along  with  so  much 
else  in  our  modern  madness  for  material 
things.  This  instruction  of  boys  and  girls 
should  do  much  to  frustrate  the  counterfeit 
affections  and  vices  which  modernity  has 
thrust  upon  us. 

The  need  of  hereditary  quality — a  better 
breed — is  painfully  evident  in  the  world 
today.  There  will  be  no  better  opportunity 
of  impressing  this  need  than  at  this  mo- 
ment of  sex  teaching  and  it  will  do  much  in 
lifting  to  a  higher  level  the  world's  habit 
of  thinking  in  this  department  of  life. 

And  we  must  look  more  to  the  women  of 
the  race  in  the  future  to  safeguard  poster- 
ity. Women  are  destined  to  have  a  larger 
role  in  the  destiny  of  man  than  they  have 
ever  had  in  the  past;  and  it  is  time  that 
education  to  that  end  should  be  available 
to  them.  If  we  are  going  to  have  a  better 
progeny  our  present  methods  and  aims  of 


76  CONTROL  OF  SEX  INFECTIONS 

sexual  selection  will  have  to  be  mucli  re- 
paired. * 'Social"  advancement,  money, 
ease,  luxury — these  are  the  moving  factors 
in  too  many  of  our  marital  adventures  of 
today.  And  adventures  they  too  plainly 
often  prove  to  be.  That  many  are  married 
but  few  are  mated,  is  all  too  apparent. 

One  has  to  make  but  a  short  excursion 
into  this  realm  of  sexual  life  to  see  the 
need  of  sexual  instruction  if  we  are  to  bar 
from  the  future  the  bitter  fruits  of  our 
present  social  depravity,  and  our  sexual 
diseases. 


CHAPTER  VII 

THE  IMPORTANCE  OF  UNIVERSAL 
TRAINING  TO  SEXUAL  HEALTH 

Before  pointing  to  any  measures  for  the 
care  and  control  of  sexual  infections  which 
might  be  advantageously  incorporated  with 
a  national  system  of  training,  it  will  be 
well  to  look  for  a  moment  at  universal 
training  as  a  social  factor  capable  of  in- 
fluencing the  underlying  causes  of  these 
diseases. 

This  can  best  be  done  by  a  short  review 
of  this  scheme  of  training,  which  in  this 
or  some  similar  form  is  bound  in  the  future 
to  be  installed  as  an  absolutely  necessary 
health  and  educational,  as  well  as  national 
defense,  measure  for  this  country.  It 
would  not  be  pleasant  to  have  to  bring  the 
mind  to  a  belief  that  our  national  stupidity 
could  be  so  complete  as  to  take  any  other 
view  of  the  matter. 

77 


78      CONTROL  OF  SEX  INFECTIONS 

A  moderate  and  yet  what  would  seem  to 
be  an  adequate  plan  for  universal  military 
training  has  been  formulated,  placed  before 
Congress  and  received  the  commendation 
of  the  highest  military  authority  as  well 
as  some  of  the  best  minds  in  the  land. 

It  has  been  pointed  out  that  the  sixteen 
cantonments  built  at  a  huge  expense  by 
the  Government  for  the  training  of  the  re- 
cent national  army,  would  be  suitable  for 
universal  training  and  the  accompanying 
vocational  instruction  in  appropriate 
trades  which  are  as  important  in  time  of 
peace  as  in  war.  It  goes  without  saying 
that  under  a  system  of  universal  training 
and  with  a  reserve  built  up  thereby  only 
a  small  regular  army  would  be  necessary. 
The  evils  and  immoralities  of  a  large 
standing  army,  or  for  that  matter  of  any 
sized  professional  soldier  force  of  un- 
married men,  is  all  too  well  known. 

The  maintenance  of  a  large  standing 
army  means  the  maintenance  of  a  large 
permanent  professional  prostitute  class. 
The  maintenance  of  a  large  professional 


IMPORTANCE  OF  UNIVERSAL  TRAINING       79 

naval  establishment  means  exactly  the 
same  thing.  On  that  score  we  should 
know  exactly  what  we  are  doing  if  we 
vote  down  universal  training. 

A  small  professional  army  only,  backed 
by  a  trained  ditizen  Reserve,  means  the 
possibility  of  early  marriage  for  the  many; 
for  universal  training  would  put  no  bar  to 
matrimony  as  does  three  or  five  years'  en- 
listment periods  in  army  or  navy  service. 
Again  we  should  know  exactly  what  we  are 
doing  when  we  put  obstacles  in  the  way 
of  marriage. 

For  a  fighting  force  pick  out  married 
men  every  time — men  with  wives  and 
homes  and  family  honor  to  protect.  Also 
men  who  are  not  liable,  to  the  tune  of  one 
in  twenty,  to  be  unfitted  by  a  sexual  dis- 
ease. 

A  very  brief  outline  of  the  plan  will 
be  all  that  it  is  necessary  to  give  here. 
There  should  be  a  short  period  of  six 
months '  training  for  the  male  youth  of  the 
country  on  reaching  the  age  of  18  or  19 
years. 


80  CONTROL  OF  SEX  INFECTIONS 

This  would  be  under  direct  Federal  con- 
trol, in  either  the  army  or  navy  as  pre- 
ferred. 

For  the  illiterate  and  non-English  speak- 
ing there  would  be  educational  camps  for 
a  period  of  three  months  preceding  the 
regTilar  period.  Have  we  not  heard  some- 
where that  about  24.9  per  cent.,  of  the  young 
men  of  the  country  would  qualify  for  this 
preliminary   educational  advantage? 

It  was  proposed  to  naturalize  aliens 
automatically  who  graduated  from  the 
course  of  training  required. 

All  young  men  on  passing  out  of  the 
training  camps  would  for  a  period  of  ten 
years  be  on  the  reserve  list  and  during  the 
first  ^ve  years  have  several  short  periods 
(two  or  three  weeks)  of  training  so  that 
they  would  not  forget  what  they  had 
learned;  they  would  thus  remain  conscious 
of  the  responsibility,  and  so  form  that  habit 
of  responsibility  of  citizenship  which  with- 
out giving  service  to  one's  country  is  so 
prone  to  be  lacking  in  periods  of  peace. 

During  this  reserve  period  of  ten  years 
each  young  man  would  have  the  benefit  of 


IMPORTANCE  OF  UNIVERSAL  TRAINING      81 

an  annual  physical  examination  and  medi- 
cal treatment  if  necessary.  He  would 
make  also  an  annual  report,  thereby  realiz- 
ing that  he  is  on  the  books,  as  it  were,  of 
his  country  and  a  person  of  some  impor- 
tance, instead  of  a  creature  with.no  indi- 
viduality or  identity.  The  psychological 
result  of  this  is  patent. 

It  is  not  the  business  of  this  book  to 
attempt  to  influence  the  intelligent  reader 
towards  taking  a  favorable  view  of  this 
project  of  universal  military  training  in 
order  that  he  will  advance  its  cause,  for  it 
is  unthinkable  at  the  present  time  that  any 
lucid  minded  citizen  is  not  doing  this  very 
thing  for  the  perfectly  obvious  reasons 
which  necessitate  it,  and  which  are  quite 
aside  from  the  advantages  which  it  is  the 
object  of  this  chapter  to  point  out. 

Now  what  are  these  advantages? 

First  and  foremost  is  the  socializing  fac- 
tor which  would  carry  some  real  influence 
in  the  uprooting  of  the  underlying  causes 
of  these  diseases  to  which  reference  has 
been  made. 

With  the  results  of  the  modern  Indus- 


82  CONTROL  OF  SEX  INFECTIONS 

trial  and  commercial  stampede  before  onr 
eyes;  where  communities  are  packed  with 
these  wage-dependent  workers,  male  and 
female ;  where  marriage  is  delayed  or  aban- 
doned and  where  respect  for  good  manners 
or  morals  is  unheard  of  and  where  sexual 
infections  have  pretty  much  their  own  way, 
the  time  does  seem  almost  ripe  to  introduce 
into  our  national  society  some  of  the  re- 
straining influences  of  discipline,  a  regard 
for  order  and  decency,  self-control  and 
some  educational  assets.  And  it  is  these 
things  which  form  the  essence  of  the  well 
conducted  army  training  camp  atmosphere, 
from  which  no  normal  young  man  can  issue 
forth  without  bearing  the  marks  of  better- 
ment. But  what  is  even  more  fundamental 
than  these  are  the  physical  training  and  de- 
velopment, and  the  secrets  of  health  which 
whet  the  appetite  for  clean,  orderly  and 
purposeful  living.  Some  self-reliance 
might  come  to  be  established  in  the  indi- 
vidual youth  and  prospective  citizen — 
some  courage  and  character  which  would 
help  to  pry  him  loose  from  the  mass  de- 
pendence and  give  him  the  confidence  and 


IMPORTANCE  OF  UNIVERSAL  TRAINING      83 

wit  to  bargain  for  his  own  employment  or 
start  liim  off  on  some  individual  form  of 
livelihood  which  is  even  better. 

This  era  of  industrialism  which  has 
been  such  a  hindrance  to  human  progress 
and  such  a  fertile  soil  for  sexual  depravity 
while  it  has  been  so  busy  about  its  material 
accretions  would  in  part  be  counteracted. 

Once  this  fatal  habit  of  dependence  on  a 
job  could  be  broken,  this  wage-slave  form 
of  discontented  mind  be  cured,  the  out- 
stretched hands  to  charity  withdrawn,  and 
in  its  place  the  hot  blood  of  self-respect 
and  independent  manhood  set  circulating, 
our  eyes  might  now  and  then  be  greeted 
by  the  wholesome  sight  of  a  vigorous 
pioneer  going  forth  to  claim  the  treasures 
of  the  open  air  and  fruitful  soil.  We 
might  even  see  some  of  the  abandoned 
farms  once  more  peopled  by  earnest,  hon- 
est folk  surrounded  by  their  healthy  and 
happy  children;  and  with  such  redeeming 
signs  as  these  a  real  pride  in  our  nation 
might  again  be  reborn. 

Along  with  the  physical  upbuilding,  edu- 
cational development  and  the  Americaniz- 


84  CONTROL  OF  SEX  INFECTIONS 

ing  influence  which  universal  training 
could  bring  about,  the  power  to  set  aright 
the  minds  of  the  young  men  regarding  the 
evils  of  alcohol,  opium  and  other  drugs 
could  be  most  effectively  impressed.  This 
must  take  no  small  part  in  this  scheme  for 
the  national  training  of  our  youth  if  we  are 
sincere  in  the  desire  to  see  humanity  saved 
from  the  despoiling  influence  of  these 
poisons.  This  deeply  concerns  any  effort 
in  the  weeding  out  of  sexual  diseases  as  the 
chapter  on  the  role  of  alcohol  in  relation 
to  these  maladies  pointed  out;  and  the  re- 
sults of  teaching  the  youth  of  the  country 
as  they  come  to  their  term  of  training,  will 
be  greater,  I  believe,  than  the  results  of 
prohibiting  the  manufacture  and  sale  of 
alcohol. 

Universal  training  as  a  factor  working 
toward  the  elimination  of  prostitution  can 
be  made  both  direct  and  indirect. 

It  will  be  direct  by  the  right  training  of 
the  youth  toward  a  clean  and  productive 
life,  and  by  the  encouragement  of  early 
marriage  which  a  young  man  properly 
equipped  vnth  vocational  and  educational 


IMPORTANCE  OF  UNIVERSAL  TRAINING       85 

training  will  be  better  able  to  undertake 
than  at  present. 

It  will  be  indirect  by  the  results  of  this 
training  which  lead  'to  early  marriage  and 
by  the  graphic  lesson  which  it  is  possible 
to  give  of  the  frightful  consequences  of 
sexual  diseases. 

Having  seen  then  some  of  the  possibil- 
ities of  universal  training  in  its  influence 
on  the  social  background  of  these  sex  in- 
fections, let  us  see  what  medical  measures 
of  practical  value  could  be  incorporated 
with  such  a  system  of  general  training. 
For  this  we  need  only  look  back  to  our 
recent  war  experience  to  gather  informa- 
tion ;  for  what  we  did  not  learn  from  prac- 
tice we  learned  from  our  mistakes,  and  the 
linking  of  the  two  may  be  looked  upon  as 
good  ground  work  for  an  excellent  start. 

In  each  training  camp  there  must  of 
course  be  a  general  hospital  and,  as  in  our 
recent  camps  and  cantonments,  a  special 
department  for  the  care  of  sexual  diseases. 
This  branch,  however,  must  be  managed  by 
an  expert  who  has  with  him  trained  assist- 
ants. 


86  CONTROL  OF  SEX  INFECTIONS 

The  fundamentals  of  this  work  must  be 
standardized  if  uniform  results  are  to  be 
expected. 

A  good  many  cases  of  these  diseases 
may  be  looked  for,  unless  a  miracle  has 
transformed  our  social  state  since  we 
drafted  three  or  four  million  young  men  in 
1917  and  '18.  But,  differing  from  that  ex- 
perience, we  should  be  ready  for  these 
infections  with,  specialists  and  adequate 
equipment.  In  this  way  those  infected  will 
not  only  get  the  best  care  possible,  but  will 
receive  a  lesson  as  to  what  is  the  proper 
treatment  of  these  diseases.  It  mil  be 
possible  under  universal  training  to  keep 
the  infected  under  treatment  until  cured 
or  freed  from  their  infectiousness ;  for  this 
can  be  carried  on  under  government  control 
even  after  their  period  of  training  is  com- 
pleted. 

Those  who  are  infected  during  their  pe- 
riod of  training  can  receive  the  prompt 
treatment  which  assures  a  cure  in  many 
cases  in  a  surprisingly  short  period  as  com- 
pared with  the  older  methods.  Medical 
prophylaxis  however  should  prevent  the 


IMPORTANCE  OF  UNIVERSAL  TRAINING      87 

occurrence  of  many  such  cases.  And  as 
we  make  progress  in  this  campaign  along 
educational  and  social  lines  the  occurrence 
of  these  disorders  should  grow  less  fre- 
quent. 

All  young  men  as  they  pass  through 
their  course  of  universal  training  Avhether 
they  come  infected,  or  become  infected,  or 
remain  free  from  infection,  will  receive 
full  instruction  (as  did  certain  groups  of 
our  recent  national  army  lucky  enough  to 
get  where  there  was  some  system  in  this 
department  of  medicine)  both  as  to  the 
nature  and  danger  of  these  maladies,  as 
well  as  their  correct  care  and  avoidance. 
Let  the  reader  pause  for  a  moment  to  con- 
sider the  significance  of  such  a  stupendous 
blow  at  this  plague.  Think  of  it !  Every 
youth  in  the  land  instructed  concerning 
these  diseases.  No  social  effort,  no  health 
department  service  can  for  many  years 
effect  in  the  coming  campaign  on  these  dis- 
eases what  it  is  possible  to  accomplish  with 
universal  military  training,  at  one  blow. 
I  think  we  can  conservatively  say  that  no 
single  measure  at  our  disposal  can  accom- 


88  CONTROL  OF  SEX  INFECTIONS 

pKsh  what  the  universal  training  system  is 
capable  of  accomplishing  in  this  depart- 
ment of  hygiene. 

Let  any  citizen  who  for  any  reason  does 
not  favor  universal  training  of  the  youth 
of  the  land  bear  this  in  mind:  That  the 
economic  saving  alone  in  human  efficiency, 
if  these  diseases  could  be  adequately  con- 
trolled, would  probably  almost,  if  not  en- 
tirely, pay  the  bill  for  this  national  system 
of  defense  and  development,  once  it  was 
properly  established. 

So  much  then  for  universal  training  of 
the  male  youth  of  this  country  and  its  pos- 
sibilities in  the  upbuilding  of  our  national 
manhood  as  well  as  the  undoing  of  our 
sexual  infections. 

But  how  about  the  girls  who  are  grow- 
ing into  womanhood?  Are  they  to  receive 
no  training!  Are  they  to  receive  suffrage 
and  give  no  service  ?  This  is  a  very  perti- 
nent as  well  as  a  very  important  question 
of  a  most  practical  nature  at  this  moment 
of  social  reconstruction.  That  all  young 
women  should  receive  some  training  in  the 
fundamental     duties     pertaining    to     the 


IMPORTANCE  OF  UNIVERSAL  TRAINING      89 

woman's  sphere  is  no  new  thought,  for  it 
was  under  discussion  long  before  the  great 
war  came  upon  the  world,  in  countries  so- 
cially more  advanced  than  our  own.  In 
the  light  however  of  the  great  social 
changes  going  on  everywhere  the  idea  of 
some  suitable  form  of  universal  training 
for  young  women  truly  lifts  before  the 
lively  mind  new  levels  of  hope.  To  think 
of  a  womanhood  of  healthy,  strong,  trained 
and  capable  individuals,  is  to  think  alto- 
gether in  new  terms  of  life ;  and  this  is  the 
moment  for  our  minds  to  bend  to  thoughts 
which  carry  with  them  a  promise  of  better 
things  for  our  children.  Soon,  when  the 
present  flux  of  opinion  becomes  fixed  into 
new  and  rigid  conventions  again,  like  the 
broken  leg  which  is  badly  set,  the  time  for 
a  brilliant  result  will  have  passed  and  we 
shall  have  nothing  better  than  the  same  old 
crutches  to  limp  along  on.  It  would  seem 
worth  while  then  to  take  a  short  mental 
excursion  into  this  idea  of  universal  train- 
ing for  girls  and  see  if  in  the  interior  of 
the  thought  there  is  really  anything  to  hold 
our  attention. 


90  CONTROL  OF  SEX  INFECTIONS 

Let  US  say  that  nine  or  ten  montlis  was 
the  period  of  training  which  each  girl  as 
she  reaches  the  age  of  16  or  17  years  would 
be  required  to  take. 

She  would  start  off  with  a  three  months' 
summer  period  of  outdoor  camp  instruc- 
tion and  physical  development.  The  mind 
can  easily  imagine  with  what  eagerness  all 
normal  young  girls  Avould  be  looking  for- 
ward to  this  experience;  but  it  would  be 
difficult  for  the  mind  to  measure  off-hand, 
what  the  value  of  this  would  be. 

The  greater  part  of  the  time  in  this  pe- 
riod would  be  devoted  to  agreeable  physi- 
cal exercises  and  games  in  the  open;  but 
they  would  be  governed  by  order,  punc- 
tuality, fair  play  and  good  temper,  and  the 
principles  of  discipline  would  be  developed. 
All  girls  at  this  period  would  be  learning 
how  to  care  for  and  look  out  for  themselves. 
They  would  make  their  o^m  beds  and  keep 
their  living  quarters  up  to  the  sanitary 
standard  of  cleanliness  and  order.  They 
would  wear  some  regulation  but  simple 
uniform  or  costume.  By  their  outdoor  ex- 
ercises and  healthful  regime  they  would 


IMPORTANCE  OF  UNIVERSAL  TRAINING      91 

learn  how  nature  applies  her  cosmetics  to 
complexion,  cheeks,  eyes  and  lips — perhaps 
in  time  the  face-paint  and  powder  mer- 
chants would  take  ilp  some  more  desirable 
trade  and  the  drug-stores  resume  the  sale 
of  drugs.  During  this  period  a  couple  of 
hours  a  day  could  be  devoted  to  useful  in- 
struction, graphically  and  thus  impres- 
sively given,  of  a  fundamentally  and  uni- 
versally important  character — things  that 
every  wom^an  should  know,  such  as: 
Health  and  how  to  maintain  it ;  illustrated 
by  a  little  simple  physiology  and  anatomy 
coupled  ^th  the  principles  of  bodily  hy- 
giene. Food;  its  values  and  how  to  pre- 
pare it,  from  the  standpoint  of  economy 
and  efficiency,  as  well  as  the  palate. 
Household  sanitation  and  order.  Cloth- 
ing; the  value  of  simple  and  wholesome 
dress.  Sexual  instruction.  The  impor- 
tance of  physical  (including  muscular) 
strength  and  health;  as  opposed  to  the 
present  average  condition  and  conduct  of 
women,  which  is  making  motherhood  a  sac- 
rilege. The  processes  of  impregnation 
and  reproduction  and  the  dangers  of  the 


92  CONTROL  OF  SEX  INFECTIONS 

sexual  infections  to  these  and  to  the  child. 
Instruction  on  social  subjects,  such  as  pub- 
lic welfare,  order,  safety  and  sanitation. 
Instruction  in  the  principles  of  government 
and  the  responsibilities  of  suffrage. 
Fairly  grounded  on  these  subjects  women 
can  safely  sit  in  Congress. 

During  these  first  three  months  of  bodily 
training,  with  a  httle  useful  information 
— something  like  the  above — added  to  it, 
a  very  exact  estimate  could  be  made  of 
the  physical  and  mental  status  of  each  girl. 
This  might  serve  several  good  purposes, 
but  the  two  most  concerning  us  here  would 
be,  first,  that  a  reliable  statistical  record 
would  be  gained  for  future  guidance  in  such 
a  system  of  universal  training  for  girls, 
and  second,  a  record  which  would  be  of  im 
mediate  value  in  estimating  just  what  prac- 
tical service  each  girl  would  be  best  suited 
for  in  completing  her  course  of  training. 

This  second  period  of  training  devoted 
to  practical  work  should  aim  to  ultimately 
become  of  economic  value  to  the  Govern- 
ment while  serving  to  train  the  girl.  The 
following  might  be  taken  as  illustrative  of 


IMPORTANCE  OF  UNIVERSAL  TRAINING      93 

such  work  as  would  fall  within  this  cate- 
gory :  First  the  arts  of  housekeeping  such 
as  cooking,  sewing,  gardening  and  the  like, 
all  of  which  would  'be  taught  on  the  basis 
of  order,  cleanliness  and  economy.  The 
reader  will  not  miss  the  broad  field  this 
opens  up  for  cultivation.  To  these  things 
a  taste  for  beauty  and  harmony  could  ad- 
vantageously be  cultivated. 

Outside  those  domestic  duties  which  aim 
at  some  perfection  of  the  home  lie  the  ob- 
ligations of  social  welfare;  and  here  it  is 
that  the  training  of  the  girl  would  embody 
not  only  some  of  the  most  useful  of  the 
actual  lessons  of  life ;  but  it  would  be  here 
also  that  her  service  might  become  of  some 
economic  value  to  the  Government.  In  the 
field  of  social  service,  in  district  nursing, 
in  the  care  of  babies,  in  federal,  state,  and 
municipal  hospitals,  in  diet  kitchens  and 
many  other  community  institutions  these 
young  government  uniformed  assistants 
might  for  a  certain  period  of  their  train- 
ing actually  become  factors  of  financial 
saving.  With  the  cooperation  of  the  Pub- 
lic Health  Nurse  a  system  might  be  worked 


94  CONTROL  OF  SEX  INFECTIONS 

out  whereby  a  part  of  the  girls'  training 
might  become  a  very  useful  one  to  society 
at  large.  This  guidance  would  at  least 
give  them  an  insight  into  what  may  at  pres- 
ent be  considered  one  of  the  great  social 
advancements  of  the  day — that  of  Public 
Health  Nursing. 

In  each  state  the  state's  facilities  for 
social  welfare  work  could  be  surveyed  in 
order  to  fit  in  the  scheme  of  universal  train- 
ing for  girls  mth  that  which  has  already 
been  built  up  for  social  work  within  the 
state.  It  can  readily  be  seen  that  this 
would  of  necessity  do  much  to  standardize 
this  most  important  public  health  and  edu- 
cational activity. 

During  all  this  period  of  practical  train- 
ing the  girls  would  be  under  the  supervision 
and  direction  of  their  commanding  officers, 
so  to  speak.  A  certain  amount  of  outdoor 
physical  exercises  would  be  required,  or 
calisthenic  exercise  inside  if  climate  or 
weather  made  that  necessary;  so  that  the 
habit  of  muscular  activity  would  be  estab- 
lished. They  would  be  required  to  keep 
neat  in  their  appearance  and  keep  their 


IMPORTANCE  OF  UNIVERSAL  TRAINING      95 

bodies  clean,  their  teeth  carefully  brushed, 
and  all  other  habits  pertaining  to  bodily 
hygiene  firmly  fixed.  Short  courses  of  in- 
struction to  make  clear  all  the  work  they 
were  given  to  do  would  be  given;  and  effi- 
ciency records  would  be  kept  of  each  indi- 
vidual, along  with  her  personal,  physical, 
and  mental  status  and  development. 

Unlike  the  training  of  the  male  youth, 
who  would  be  placed  on  a  reserve  basis,  the 
girls  could  be  turned  back  to  their  homes 
at  the  end  of  the  training  period  as  having 
graduated  from  their  obligatory  service; 
but  records  of  each  would  be  had  and  in 
case  of  a  national  emergency  the  recruiting 
of  trained  and  efficient  assistants  would  be 
accomplished  without  difficulty. 

With  this  annual  inventory  of  our  matur- 
ing human  values  to  go  forward  from  we 
could  perhaps  build  the  foundation  of  some 
real  national  and  individual  worth. 

The  conventionalized  parents  of  some 
girls  would  at  first  see  difficulties  in  the 
necessary  hiatus  in  their  school  curricu- 
lum, but  for  the  great  majority  it  would  be 
a  great  and  ennobling  finish  to  the  school 


96  CONTROL  OF  SEX  INFECTIONS 

days  of  their  early  life  and  a  sound  begin- 
ning for  their  future  individual  and  social 
usefulness.  And  by  our  usefulness  must 
we  largely  measure  the  satisfaction  of  hu- 
man existence. 

But  the  reader  may  justly  ask,  what  has 
this  to  do  with  the  control  of  sexual  infec- 
tions? As  in  the  male  youth  of  the  land 
it  would  give  a  universal  knowledge  as  to 
these  conditions,  and  few  girls,  who  actu- 
ally knew  what  these  diseases  mean  to  a 
woman,  would  lightly  jeopardize  all  the 
health  and  happiness  of  life.  As  probably 
the  large  majority  of  prostitutes  are  what 
they  are  because  they  have  no  knowledge 
or  experience  of  how  to  take  care  of  them- 
selves and  earn  a  reputable  living,  one  of 
the  main  reasons  for  prostitution  would 
perish.  More  women  being  physically  and 
othermse  fitted  to  be  married  and  make 
good  wives,  mothers  and  actual  helpmates, 
would  undoubtedly  be  married.  After  a 
girl  has  had  this  socializing  benefit,  the 
knowledge  and  physical  development  as 
well  as  given  an  identity  through  service 
to  her  country,  it  is  difiicult  to  think  she 


IMPORTANCE  OF  UNIVERSAL  TRAINING      97 

would  be  so  apt  to  fall  or  be  led  into  prosti- 
tution. So  by  these  and  many  other  ways 
it  is  not  hard  to  see  how  universal  training 
for  the  young  women  would  diminish  pros- 
titution and  the  sexual  infections,  while  in- 
suring sexual  safety  and  the  promise  of  a 
better  race. 


CHAPTER  VIII 

syste:\iatic  care  of  the  sexual 
infections 

Here  is  the  logical  beginning  of  this 
whole  matter — the  reduction  of  sex  disease 
carriers  by  prompt  and  proper  care.  This 
is  society ^s  first  task;  to  see  that  all  hos- 
pitals are  adequately  prepared  with  a  ra- 
tional system  and  a  reliable  staff  to  meet 
the  situation  which  exists  in  all  commun- 
ities. Society's  first  task;  for  it  is  even 
more  largely  due  to  society's  near-sighted 
taboo  than  to  the  indifference  of  the  med- 
ical profession  as  a  whole  that  means  of 
scientifically  dealing  with  these  diseases  as 
a  routine  have  been  so  entirely  wanting. 
Though  in  the  past  many  fashionable  hos- 
pitals declined  to  take  ^^disagreeable''  dis- 
eases, such  as  cancer  or  syphilis  or  gono- 
coccus  infection  and  give  them  beds  when 
bed  treatment  meant  everything  to  the  pa- 


SYSTEMATIC  CARE  99 

tient's  prospects  of  relief  and  cure,  the  fu- 
ture will  necessarily  be  colored  by  a  differ- 
ent policy  if  we  are  going  to  war  against 
these  veritable  enemies  of  the  flesh.  For 
it  is  war  upon  these  diseases,  it  is  to  be 
remembered ;  not  war  upon  the  individuals 
or  their  morality,  or  their  religion,  or  their 
occupation,  or  their  class  of  society;  but 
war  upon  the  germ  factor  of  these  maladies 
— clean,  straight,  unprejudiced,  scientific 
warfare,  which  is  the  first  business  of  the 
hospital  and  of  the  physician.  Without  the 
establishment  of  trustworthy  departments 
for  the  care  of  sexual  diseases,  either  as 
independent  units  as  they  are  now  plan- 
ning for  in  Great  Britain,  or  as  special 
services  in  existing  hospitals,  there  will  be 
very  little  progress  made  by  broad-cast  ad- 
vice to  infected  individuals  to  go  and  get 
good  medical  counsel  and  treatment.  For 
until  by  institutional  experience  scientific- 
ally standardized  methods  are  worked  out 
and  developed  there  will  be  no  reliable 
standard  for  physicians  at  large  to  live  up 
to;  and  those  who  know  anything  about 
medical  matters  know  exactly  what  that 


100  CONTROL  OF  SEX  INFECTIONS 

means.  There  are  already  a  large  number 
of  medical  men  who  can  be  considered  well 
equipped  experts  in  the  treatment  of  sex- 
ual diseases ;  but  how  many  of  the  sex-in- 
fected come  under  their  care  first  hand? 
If  the  truth  could  be  known  the  number 
would  prove  to  be  very  small.  Unfortu- 
nately it  is  just  this  first  hand  treatment 
upon  which  so  much  depends.  We  cannot 
hope  for  such  a  fortunate  falling  out  of 
events  as  would  see  all  the  freshly  infected 
people  of  the  future  coming  promptly  un- 
der the  care  of  special  and  experienced 
workers  in  this  department  of  medicine; 
but  we  can  hope  to  see  the  early  mishand- 
ling of  these  ill-favored  individuals  very 
largely  remedied.  This  will  best  be 
brought  about  by  setting  a  standard  of 
care  in  our  institutional  treatment  of 
these  cases  just  as  the  surgical  care  for 
the  individual  with  an  attack  of  appendi- 
citis has  been  developed  and  become  a  safe 
routine  procedure  in  the  vast  majority  of 
such  cases.  When  the  scientific  and  suc- 
cessful care  of  these  diseases  comes  to  be 
more  or  less  common  knowledge   among 


SYSTEMATIC  CARE  101 

people  generally,  the  quack  quick-cure  of 
newspaper  advertising  fame,  the  dispens- 
ing drug-store  clerk  and  the  spurious 
specialist  who  have  all  been  consigning 
these  cases  to  the  incurable  class,  will  com- 
mence to  vanish.  When  many  general 
practitioners  at  large  come  to  realize  that 
the  patients  themselves  have  come  to  learn 
the  difference  between  purposeful,  scien- 
tific treatment  and  a  bluff  at  knowing  these 
diseases  and  how  to  handle  them,  they  will 
be  very  apt'  (for  reasons  best  known  to 
themselves)  to  either  acquire  the  requisite 
knowledge  and  skill,  or  send  these  patients 
where  they  can  receive  proper  care. 

More  than  one  curious  fact  both  in  the 
medical  world  and  out  of  it  was  made  evi- 
dent by  the  war  when  it  threw  up  upon 
the  shore  of  peace  its  testimony.  When 
the  United  States  emerged  from  its  belli- 
cose experience  its  medical  assets  for  the 
general  care  and  control  of  sexual  infec- 
tions became  painfully  plain.  While  in 
practically  all  other  branches  of  medicine 
there  was  some  system,  some  cohesion 
which  gave  them  a  useful  functioning  basis 


102  CONTROL  OF  SEX  INFECTIONS 

with  which  to  do  creditable  work,  the  de- 
partment which  dealt  with  genito-nrinary 
ills  went  out  of  the  army  and  navy  service 
very  much  as  it  went  into  it — represented 
by  a  scattered  few.  But  to  that  scattered 
few  there  still  clings  much  valuable  memory 
and  experience  from  their  work  with  the 
sexual  disease  situation  which  may  serve 
society  a  very  useful  purpose. 

In  giving  the  following  sketch  of  a  sys- 
tematic scheme  for  the  care  of  sexual  in- 
fections which  we  set  up  in  one  of  our 
army  camp  hospitals  during  the  latter  part 
of  the  war  it  must  not  be  supposed  that 
this  plan  is  to  be  considered  the  last  word 
in  the  organization  of  a  department  for 
these  diseases ;  but  rather  is  it  to  be  looked 
upon  in  the  light  of  a  simple  stepping- 
stone  which  may  serve  some  small  purpose 
in  our  progress  toward  a  universally  use- 
ful standard.  It  is  also  to  be  remembered 
in  reviewing  this  army  experiment  that  no 
such  complete  control  of  the  situation  is 
likely  suddenly  to  be  had  in  any  civil  com- 
munity under  peace-time  conditions. 

Before  the  work  was  begun  the  plans 


SYSTEMATIC  CAEE  103 

were  fully  laid  out  by  drawings,  models 
and  description.  It  was  then  laid  before 
the  medical  officers  of  the  hospital  and 
camp  in  order  not  only  to  get  their  criticism 
but  to  get  their  intelligent  cooperation  in 
what  was  such  an  important  phase  of  army 
medical  work;  for  unless  a  general  under- 
standing of  any  new  organization  is  had, 
the  objective  aimed  for  is  not  apt  to  be 
reached.  While  it  was  with  the  idea  of 
putting  the  collective  care  of  these  infec- 
tions on  an  orderly  basis,  there  were  three 
specific  purposes  which  were  set  down  as  its 
special  goal.  First,  the  importance  of  put- 
ting these  diseases  under  treatment  at  the 
earliest  possible  period  of  their  onset. 
Second,  the  employment  of  means  which 
would  materially  shorten  the  period  of  in- 
fection. Third,  to  get  a  more  definite  as- 
surance as  to  the  completeness  of  cure. 
All  of  which  has  been  previously  much  neg- 
lected. 

The  first  purpose  was  made  very  plain 
to  all  medical  officers  who  were  apt  to  see 
these  cases  in  the  field.  In  cases  of  a 
doubtful  genital  sore   (nearly  all  genital 


1Q4  CONTROL  OF  SEX  INFECTIONS 

sores  are  doubtful)  the  danger  of  any  anti- 
septic application  or  treatment  which  ruins 
the  dark  field  microscopic  diagnosis  of 
syphilis  was  emphasized,  and  directions  to 
send  immediately  all  such  cases  to  the 
genito-urinary  service  in  the  hospital  was 
made  very  clear.  In  cases  of  any  urethral 
discharge  or  complaint  of  premonitory 
symptoms,  all  such  (mthout  temporizing 
treatment)  were  to  be  prom]3tly  sent  to  the 
genito-urinary  department. 

This  matter  of  getting  at  these  patients 
at  the  earliest  possible  moment  of  their  dis- 
ease is  here  especially  stressed,  because 
upon  this  opportunity  alone  is  built  all  that 
is  most  useful  in  any  systematic  plan  of 
care.  An  individual  who  loses  the  chance  of 
treatment  during  the  first  few  days  or  the 
first  week  of  his  or  her  gonorrheal  dis- 
charge, or  the  one  who  has  a  genital  sore 
and  is  not  treated  immediately,  loses  the 
high  opportunity  of  a  short  period  of  infec- 
tion, and  loses  the  opportunity  for  the 
definite  cure  which  only  this  early  entrance 
upon  treatment  can  assure.  Let  there  be 
no  misunderstanding  about  the  importance 


SYSTEMATIC  CARE  105 

of  getting  the  proper  treatment,  at  this 
first  moment,  of  a  sexual  disease;  for  it 
is  at  this  point  in  the  sex  disease  road  that 
ruin  has  been  spelled  out  for  the  vast  num- 
ber by  the  individual's  ignorance,  or  by  the 
quack,  or  the  drug  clerk,  or  some  other  in- 
dividual who  is  not  qualified  to  care  for 
these  cases. 

In  the  establishing  of  this  army  depart- 
ment three  buildings  approximating  three 
hundred  beds  and  ample  room  space  for 
examinations,  records  and  treatment  were 
placed  at  the  disposal  of  the  chief  of  the 
service,  and  let  me  say,  that  in  this  instance 
all  the  equipment  required  was  as  promptly 
as  possible  provided. 

To  draw  a  finely  detailed  picture  of  this 
department  in  full  action  would  dispropor- 
tion this  little  book,  and  perhaps  not  leave 
the  essentials  quite  as  clearly  emphasized 
in  the  reader's  mind,  as  a  view  more  or 
less  in  perspective  with  the  important  and 
newer  features  in  the  foreground. 

Order  and  cleanliness  were  the  first 
favors  to  be  bestowed  on  this  department. 
The  time-honored  tradition  of  ^Hhe  worst 


106  CONTROL  OF  SEX  IKFECTIONS 

is  too  good  for  those  patients"  was 
promptly  erased  from  the  minds  of  any 
workers  on  this  service  who  showed  linger- 
ing traces  of  this  former  plan  of  treatment. 
It  was  made  very  plain  that  these  patients 
were  to  be  treated  precisely  as  any  other 
sick  patients  and  their  problems  of  sick- 
ness approached  in  exactly  the  same  scien- 
tific spirit  and  humane  manner  as  any 
other  human  ills.  The  result  of  this  was 
no  small  item  in  our  net  receipts  of  pro- 
gress and  improvement,  and  it  brought  out 
a  real  interest  in  the  pathological  study  of 
these  diseases.  Under  this  plan  the  doc- 
tors and  nurses  soon  became  as  keen  as  if 
a  lot  of  new  diseases  had  suddenly  been 
discovered. 

Before  the  professional  business  of  the 
day  was  begun  in  each  one  of  these  hun- 
dred bed  buildings,  a  short  standing  con- 
ference called  the  ^4ine  up,"  was  held. 
All  the  workers  in  that  building,  ward  sur- 
geons, nurses,  ward  men,  etc.,  came  to- 
gether and  lined  up  according  to  rank  on 
each  side  of  the  large  square  entrance  hall. 
This  assembly  served  a  number  of  pur- 


SYSTEMATIC  CARE  lOl 

poses:  We  started  the  day  by  a  ^^good 
morning,"  we  saw  that  all  were  present 
and  in  working  order.  Eeports  from  de- 
partment heads  were  heard.  Each  one 
had  a  chance  to  otfer  a  suggestion  or  voice 
a  grievance.  There  was  no  secret  diplom- 
acy; we  all  knew  just  what  we  were  head- 
ing for.  In  this  way  we  all  did  our  work 
happily,  and  got  results.  These  ^' line- 
ups'^ usually  lasted  but  a  few  minutes;  in 
fact  they  were  time  limited  as  we  went  on 
a  time  schedule.  After  the  conference,  in- 
spection of  the  building  and  all  that  it  con- 
tained, was  made.  By  going  from  one  to 
the  other  of  the  three  buildings  these  duties 
were  gotten  out  of  the  way  before  nine 
o'clock  when  professional  rounds  were  be- 
gun. In  carrying  the  reader  with  me  on 
these  rounds  special  attention  will  be  called 
to  such  innovations  as  were  instituted  to 
simplify  and  make  more  effective  the  care 
of  these  diseases. 

Starting  with  the  building  for  the  treat- 
ment of  syphilis,  chancroid  and  skin  dis- 
eases: In  the  care  of  syphilis  certain 
wards    were    assigned    for    the    different 


108  CONTROL  OF  SEX  INFECTIONS 

stages  and  types  of  tMs  infection.  Early 
cases  with  open  and  obvious  lesions  were 
placed  in  one  ward.  It  was  possible  thus 
not  only  to  isolate  these  patients  in  their 
most  infectious  period,  but  to  obtain  group 
studies  of  the  disease  in  this  way.  The 
recording  was  simplified,  the  individual 
cases  were  better  kept  in  memory  and  the 
results  of  treatment  were  more  clearly  dem- 
onstrated. When  these  patients  had  pro- 
gressed to  a  stage  of  ordinary  noninfec- 
tiousness,  their  mucous  membrane  lesions 
healed  and  their  skin  clear,  they  were 
graduated  to  another  ward  with  more  free- 
dom. Now  it  was  this  typical  early  class 
of  cases  which  constituted  a  group  with  the 
best  opportunity  for  complete  cure.  But 
just  what  constitutes  the  right  treatment 
for  a  complete  cure  has  never  been  exactly 
determined;  with  the  result  that  even  with 
a  typical  class  of  cases  no  exactness  in 
dosage  or  drugs  or  regime  has  ever  been 
made  a  general  rule.  The  consequence  of 
this  has  been  in  institutional  or  collective 
care  of  these  patients  by  what  we  might 
call  the  ^temperamental  method^'  where 


SYSTEMATIC  CAKE  109 

each  patient  is  treated  from  time  to  time, 
as  it  were,  according  to  the  particular 
fancy  or  inclination  of  this  or  that  medical 
attendant,  that  some  patients  have  doubt- 
less gotten  very  complete  cures  with  a  mini- 
mum waste  of  time  and  material;  but  the 
numbers  who  are  missing  this  desirable 
eventuality  must  be  appallingly  great  by 
the  usual  hit  or  miss  'temperamental 
method.'^ 

It  was  for  this  reason  that  we  instituted 
for  this  class  of  patients  the  formula  called 
Standard  Syphilis  No.  1,  which  was  built 
up  from  methods  of  treatment  in  the 
British  Army  and  from  recommendations 
made  by  our  own  army  Medical  Depart- 
ment (see  next  page). 

With  this  formula  will  be  seen  the  pro- 
cedure followed  in  all  ordinary  early  cases. 
It  has  a  number  of  advantages  hitherto 
not  included  in  any  single  formula  for  the 
care  of  syphilis.  Into  its  category  can 
come  the  bulk  of  the  early  cases. 

Once  it  has  been  decided  on  for  the  pa- 
tient, that  patient,  theoretically  speahing, 
is  there  and  then  assured  a  cure — a  very 


110  CONTROL  OF  SEX  INFECTIONS 


STANDARD   SYPHILIS  NO.   1 

A  routine  course  of  treatment  for  ordinary  fresh  cases  of 
sjrphilis  in  otherwise  healthy  men  (to  be  interrupted  in  the 
event  of  dermatitis,  jaundice,  or  other  signs  of  intolerance 
supervening).  Each  patient  to  be  carefully  scrutinized  for 
signs  of  stomatitis  or  general  malaise,  his  weight  to  be 
taken,    and  his   urine  tested  before  each  injection. 

In  conjunction  with  the  employment  of  this  course  of 
treatment,  each  medical  ofl&cer  shall  be  familiar  with  "Pro- 
posed Modification  of  Circular  No.  14,  W.  D.,  Office  of  the 
Surgeon-General." 

Patients  are  to  be  treated  at  base  hospital  until  open  le- 
sions are  healed,  when  they  will  be  sent  to  development  bat- 
talion  or   regimental   surgeon   for  completion   of  treatment. 

The  scheme  of  arsphenamin  dosage  is  based  on  150  pound 
men,   or  1  decigram  to  about  30  pounds  of  body  weight. 

Mercuric  Salicylate, 
33   Per  Cent. 

Arsphenamin  in  Olive  Oil. 

( Intravenously )  ( Intramuscularly ) 

Gm.  Grains. 

First    day     . 0.3  1.0 

Sixth    day    0.4  1.0 

Eleventh    day     0.4  1.0 

Eighteenth  day    0.6  1.0 

Tiventy-fifth  day    0.6  1.0 

Thirty-second  day    0.6  1.0 

Thirty-ninth  day 1.0 

Forty-sixth  day    1.5 

Fifty-third   day    1.5 

One  month  rest,  then  take  Wassermann :  If  positive,  re- 
peat entire   course ;    if  negative,   repeat  the  mercury  alone. 

At  the  end  of  the  second  course,  rest  two  months ;  then 
take  Wassermann,  and  give  third  course  in  accordance  with 
rule  for  second  course. 

During  second  year,  if  Wassermann  is  positive  repeat  en- 
tire courses  as  above.  If  negative  give  two  mercury  courses 
with   four  months  between. 


SYSTEMATIC  CARE  111 

momentous  thing  for  not  only  the  individ- 
ual but  for  society.  Practically  speaking, 
however,  we  do  not  at  all  know  that  it  is 
the  best  treatment  in  the  world.  What  the 
best  treatment  is  going  to  prove  to  be  will 
only  be  discovered  by  some  such  theoretical 
basis  which  we  start  from  and  stick  to  long 
enough  and  faithfully  enough  to  get  results 
upon  which  judgment  can  be  passed.  Per- 
haps long  before  then  a  protective  vaccine 
will  forestall  that  judgment. 

The  effect  on  the  patient  of  being 
launched  with  a  reliable  ticket  which 
should  carry  him  safely  to  the  end  of  his 
course  proved  a  very  happy  thing.  The 
formula  was  posted  so  that  all  officers, 
nurses  and  patients  could  read,  understand 
and  become  familiar  with  just  what  w^as  to 
be  expected.  The  interest  which  each  pa- 
tient took  was  remarkable,  and  the  readi- 
ness .mth  which  he  cooperated  only  attests 
further  the  advantage  of  mutual  under- 
standing in  the  furtherance  of  mutual  un- 
dertaking. 

On  the  progress  sheet  of  the  record  the 
formula  was  rubber  stamped  and  checked 


112  CONTROL  OF  SEX  INFECTIONS 

off  by  the  medical  officer  as  lie  gave  the 
treatments.  The  simplicity  of  this  record 
made  it  readable  at  a  glance. 

With  this  formula  the  surgeon's  obliga- 
tion to  see  his  patient  through  is  immensely 
lightened  by  having  so  many  steps  in  a 
long  and  wearisome  course  of  treatment 
decided  at  one  stroke. 

The  results  of  this  treatment  as  far  as 
we  went  were  highly  satisfactory  and  as 
the  patients  were  discharged  from  the  hos- 
pital their  syphilitic  register  was  stamped 
with  the  formula  Standard  Syphilis  No.  1, 
with  the  hope  that  they  would  fall  into  the 
hands  of  those  who  would  continue  its 
course. 

Of  the  atypical  cases  of  syphilis,  the 
chronic  cases  and  those  complicated  by  vis- 
ceral diseases  there  is  little  to  be  said  here, 
beyond  the  fact  that  they  were  carried 
along  in  the  general  orderly  system  under 
such  individual  treatment  as  seemed  indi- 
cated. Neither  did  the  cases  of  skin  dis- 
eases fall  under  any  formulated  class  treat- 
ment as  did  the  early  cases  of  syphilis, 
chancroid  and  gonococcus  infection. 


SYSTEMATIC  CARE  113 

The  chronic,  complicated  and  crippled 
cases  of  gonorrhea  like  the  advanced  syph- 
ilitic received  such  accredited  treatment  as 
seemed  best  suited  to  the  individual  prob- 
lem, and  all  of  this  is  adequately  dealt  with 
in  text  books  on  this  subject.  It  is  beyond 
the  boundary  of  this  book,  which  essays  to 
deal  with  the  topic  of  control  of  sexual 
infections,  to  go  into  the  discussion  of  those 
cases  which  are  the  fruits  of  our  past  in- 
difference and  neglect.  They  should  have; 
all  the  humane  and  scientific  attention 
which  we  can  give  them;  and  we  should 
see  to  it  that  their  likes  are  not  repeated 
in  the  future. 

The  early  cases  of  chancroid  were  put 
into  their  class  group  and  treated  by  means 
of  constant  cleanliness  and  exposure  to  sun- 
shine. This  rapidly  healed  the  majority 
of  these  cases.  From  the  chancroid  group 
we  constanly  reclaimed  cases  of  syphilis; 
for  of  these  cases  which  were  closely  fol- 
lowed up  with  *^dark  field"  examinations 
a  surprisingly  large  number  were  found  to 
be  thus  doubly  infected. 

Of  all  the  problems  difficult  to  face  in  a 


114  CONTROL  OF  SEX  INFECTIONS 

satisfactory  scheme  of  treatment  for  the 
sexual  diseases,  that  of  an  effective  treat- 
ment for  gonococcus  infection  must  be 
placed  first. 

Here  is  a  disease  without  a  specific  drug, 
vaccine  or  certain  remedy.  Keliable  au- 
thorities estimate  that  only  a  little  more 
than  one  out  of  ten  cases  in  the  male  are 
cured  without  an  invasion  of  the  posterior 
urethra  and  the  integrity  of  the  genital 
glands  being  violated.  The  occurrence 
which  spells  months  or  years  of  infectious- 
ness, and  all  too  often  permanent  destruc- 
tion of  tissues. 

Sixty  to  eighty  per  cent,  of  all  sexual  in- 
fections are  gonorrhea. 

It  is  said  to  be  the  most  widespread  and 
universal  disease  affecting  the  adult  male 
population.  It  is  further  said  that 
seventy-five  per  cent,  or  more  are  at  some 
time  infected.  It  provides  the  majority  of 
all  pelvic  operations  on  women,  many  of 
which  destroy  their  sex  or  render  them 
permanent  invalids. 

The  best  clinical  observers  of  this  dis- 


SYSTEMATIC  CARE  115 

ease  place  fifty  per  cent,  of  the  involuntary 
childless  marriages  at  its  door. 

More  than  twenty- j&ve  per  cent,  of  all  the 
blindness  is  due  to  it.  It  is  probably  the 
cause  of  more  social  destruction  than  any 
other  disease,  not  excluding  tuberculosis. 
By  such  tokens,  then,  can  the  gravity  of  this 
disease  be  estimated  and  the  importance 
of  its  purposeful  care  be  measured. 

And  so  it  was  that  an  adventure  into  a 
formulated  procedure  of  treatment  for  this 
disease  became  of  peculiar  interest;  for 
it  was  with  all  these  things  in  mind  that 
the  building  with  a  hundred  beds  for  an 
experiment  in  the  care  of  this  disease  was 
begun. 

We  can  set  aside  the  treatment  of  the 
chronic  and  complicated  cases  with  a  few 
words.  They  were  cared  for  with  all  the 
well  known  and  well  tried  modes  of  treat- 
ment that  had  gained  for  themselves  some 
clean-cut  claim  to  merit,  and  by  these 
means  an  effort  was  made  to  remove,  as 
far  as  possible,  from  these  scarred  and 
strictured  and  generally  outraged  tissues. 


116  CONTROL  OF  SEX  INFECTIONS 

the  infection  present.  Resentful  as  one 
often  becomes  at  this  vast  army  of  recur- 
ring chronics,  these  uncured  and  compli- 
cated cases  which  stumble  on  from  one 
stage  to  another,  it  is  hardly  fair  at  pres- 
ent to  put  these  cases  all  down  to  the 
blunders  of  either  medical  misattention  or 
blame  the  patients  themselves  while  no 
suitable  standard  for  the  successful  care 
of  the  early  infection  has  yet  become  gen- 
eral. 

As  in  the  department  for  syphilis  the 
cases  of  gonorrhea  were  separated  in  dif- 
ferent wards  according  to  their  type  or 
complication.  For  the  examination  and 
treatment  of  these  cases  in  groups  a  large 
room  was  equipped.  Down  one  side,  but 
free  in  the  room,  ran  a  trough  where  fifteen 
patients  could  receive  at  one  time  either 
injections  or  irrigations,  each  one  being 
under  the  direct  observation  of  a  medical 
officer  as  he  passed  along  in  front  of  the 
patients  under  treatment.  In  this  manner 
it  was  possible  to  see  that  each  learned  the 
proper  method  of  his  treatment.  Tables 
were    there    for    those    groups    receiving 


SYSTEMATIC  CARE  117 

instrumental  treatment.  Those  receiving 
massage  of  prostate  and  vesicles  had  their 
progress  checked  up  by  immediate  micro- 
scopic examinations.  The  strictest  surgi- 
cal cleanliness  was  observed  in  all  treat- 
ments. One  room  was  equipped  solely  for 
the  two-  or  three-glass  tests  which  were 
checked  up  and  recorded  every  morning 
with  the  first  urination — there  being  a  hun- 
dred pairs  of  urine  glasses  on  shelves 
marked  with  their  equivalent  bed  numbers. 
Twice  each  week  smears  were  taken  from 
each  patient's  urethra  before  urination, 
were  Gram  stained,  were  studied  and  re- 
corded. The  records  were  simplified  to 
the  last  degree  so  that  the  patient's  pro- 
gress could  be  read  at  a  glance.  Any 
reader  who  would  be  interested  to  see  this 
service  more  fully  described  and  illustrated 
by  pictures  is  referred  to  the  Journal  of 
the  American  Medical  Association  of  April 
26,  1919. 

Letting  this  abridged  sketch  of  the  de- 
partment for  the  care  of  gonococcus  infec- 
tion in  its  various  stages  serve  as  a  back- 
ground, we  can  turn  our  attention  to  the 


lis  CONTROL  OF  SEX  INFECTIONS 

formulated  or  special  treatment  alluded 
to.  Here  it  was  that  we  were  to  embark 
on  an  adventure  into  the  realm  of  the  gono- 
coccus  which  was  somewhat  of  a  departure 
from  the  usual  day  to  day  prescribing 
method  of  treatment. 

The  direct  object  of  this  experiment  was 
to  see  what  proportion  of  these  patients  it 
was  possible  to  bring  to  a  complete  and 
early  cure  before  the  gonococcus  had  in- 
vaded to  any  extent  the  urethral  glands  or 
follicles  or  extended  back  of  the  mem- 
branous urethra  which  guards  the  openings 
of  the  prostate  gland  and  seminal  ducts. 

To  this  end  the  uniform  treatment  was 
adopted  which  went  by  the  name  of  Stand- 
and  Gronorrhea  No.  1  (see  next  page). 

A  brief  study  of  this  shows  it  to  be  a 
succession  of  safe  and  simple  steps,  marked 
off  into  periods  or  phases ;  but  only  by  thus 
standardizing  some  plan  and  carefully  pur- 
suing it  is  it  possible  to  tell  by  what  means 
the  disease  can  most  successfully  be  treated 
and  brought  under  control. 

That  it  is  only  applicable  to  the  early 
cases  should  not  need  further  emphasis. 


SYSTEMATIC  CARE  119 


STANDARD   GONORRHEA  NO.   1 

A  routine  course  of  treatment  for  ordinary,  early  and  un- 
complicated cases  of  gonorrhea  in  otherwise  healthy  men. 
Employed  at  base  hospital  and  continued  at  development 
battalion  or  bj^  regimental  surgeon  (to  be  interrupted  in 
event  of   complications   or   intolerance). 

DURING  FIRST  TWO  WEEKS 

In  bed  from  four  to  eight  days,  then  "up"  if  inflammation 
has  subsided.  Bland  diet.  Tvi^o  glass  test  each  morning 
with  first  urination.  Smear  on  Monday  and  Thursday  morn- 
ings, before  urination.  Sandalwood  oil,  5  minims  three  times 
a  day,  and  increase  5  minims  daily  until  15  minims  three 
times  a  day,  after  eating ;  then  decrease  5  minims  daily. 
Irrigation  twice  daily  (at  5  feet,  patient  standing)  with  po- 
tassium permanganate,  1:8,000,  from  105°  to  115°  F.  The 
irrigation  not  to  be  "through,"  i.  e.,  into  the  bladder,  until 
the  patient  can  relax  without  the  slightest  discomfort.  Hand 
injections  to  be  used  while  infection  remains  anterior. 

DURING  SECOND  TWO  WEEKS 

Bland  diet  continued.  Patient  should  be  up  all  day,  and 
doing  from  two  to  four  hours  of  light  work.  Two  glass  test 
and  smear  as  before.  Do  not  repeat  Sandalwood  oil  course, 
if  improvement  is  marked  as  it  should  be.  Irrigation  twice 
daily  as  before,  with  potassium  permanganate  solution, 
1:6,000  at  6  feet,  or  hand  injections  if  infection  is  still 
anterior. 

DURING  THIRD  TWO  WEEKS 

Diet  bland,  but  increased.  Patient  should  be  having 
from  three  to  six  hours  daily  of  light  work.  Two  glass  test 
and  smear  as  before.  If  any  discharge  or  cloudiness  of 
urine  is  present,  potassium  permanganate,  1:4,000  irriga- 
tion. 

When  free  from  symptoms  (no  discharge  and  clear  urine) 
for  two  weeks,  without  treatment,  and  doing  from  three  to 
six  hours'  work  daily,  the  patient  in  most  cases  may  be  con- 
sidered fit  for  duty  and  infection  free. 

Note — In  seeking  a  useful  basis  of  treatment  for  the  ordi- 
nary run  of  gonorrheal  cases  it  can  be  easily  understood 
that  no  lesson  of  value  can  be  learned  unless  the  plan  laid 
down  is  followed  accurately  in  every  detail. 


120  CONTROL  OF  SEX  INFECTIONS 

It  will  be  the  obligation  of  a  more  enlight- 
ened future  to  see  that  the  opportunity  of 
this  first  moment  of  the  disease  is  not 
missed.  It  was  not  used  in  cases  which  had 
existed  upward  of  two  weeks,  or  in  recur- 
rent cases.  The  formula  was  strictly  ad- 
hered to  as  it  was  originally  drafted,  ex- 
cept for  the  fact  that  no  local  treatment 
(injections)  was  begTin  until  two  or  three 
days  in  bed  had  abated  the  existing  acute- 
ness  of  inflammation. 

The  progress  sheet  of  the  record  was 
ruled  oif  into  columns  describing  daily  the 
discharge,  urine,  presence  of  gonococci  and 
other  remarks.     It  could  be  read  by  a  look. 

The  result  of  this  treatment  turned  out 
to  be  far  more  satisfactory  than  was  our 
expectation,  in  so  far  as  we  were  able  to 
follow  our  cases  discharged  as  cured;  and 
this  we  were  able  to  do,  with  some  of  them, 
for  many  months. 

The  curative  results  of  this  treatment 
were  based  on  the  following  tests: 

1.  Before  being  taken  off  treatment: 
(a)  no  discharge:  (b)  a  clear  urine:  (c) 
gonococcus  free  for  a  period  of  ten  days. 


SYSTEMATIC  CARE  121 

2.  With  no  treatment;  with  no  restric- 
tion of  activity;  with  no  signs  of  disease 
for  two  weeks. 

The  average  time  of  cure,  which  included 
the  two  weeks  ^  period  of  observation,  was 
from  five  to  six  weeks. 

So  far  as  we  could  tell,  none  of  these 
patients  had  a  recurrence. 

The  best  results  were  in  those  cases 
where  there  had  been  no  previous  infection 
and  where  treatment  was  begun  during  the 
first  week  of  the  disease.  Of  these  90  per 
cent,  were  returned  to  duty  cured.  In  all 
of  these  cases  the  infection  was  cured  with- 
out extending  into  the  posterior  urethra. 
Unfortunately  there  were  only  a  small 
number  of  these  cases  for  this  study.  Only 
twenty  in  the  first  week  of  disease.  Of 
those  cases  where  the  treatment  was  begun 
during  the  second  week  of  the  disease  the 
per  cent,  of  cures  dropped  to  80  per  cent, 
in  this  average  period  of  from  five  to  six 
weeks  ^  care. 

These  unusual  results  of  what  is  prac- 
tically a  reversal  of  the  established  statis- 
tical estimate  of  cures  before  the  infection 


122  CONTROL  OF  SEX  INFECTIONS 

had  extended  from  the  anterior  to  the  pos- 
terior urethra,  we  felt  was  in  part  due  to 
the  excellent  general  condition  of  these 
soldier  patients  who  were  leading  a  vigor- 
ous outdoor  existence.  But  the  chief  fac- 
tor of  success  is  first  of  all  the  rest  in  hed. 
This  can  not  be  minimized,  and  it  is  im- 
possible to  lay  too  much  stress  on  the  im- 
portance of  this  measure  in  every  case  seen 
within  the  first  two  weeks  of  the  disease. 
Until  we  have  some  specific  remedy  for  this 
infection  it  is  the  physician's  duty  to  so- 
ciety as  well  as  to  the  patient  to  see  that 
this  essential  requirement  is  complied  with 
in  all  early  cases  of  this  disease  which  he 
sees. 

Probably  the  next  most  important  ele- 
ment in  this  standardized  treatment  is  the 
conscientiousness  and  care  with  which  it 
is  carried  out.  This  has  a  twofold  advan- 
tage. It  assures  in  capable  hands  the  thing 
being  well  done,  and  it  assures  the  full  con- 
fidence of  the  patient.  As  for  the  local 
treatment  of  injections  we  have  no  certain 
remedy,  as  is  well  known,  but  the  important 


SYSTEMATIC  CARE  123 

thing  is  to  do  no  harm  with  such  remedies 
as  we  have. 

Though  the  results  of  Standard  Gonor- 
rhea No.  1  chanced  to  be  brilhant  the  plan 
itself  required  no  special  intelligence.  It 
was  the  painstaking  sincerity  of  the  young 
medical  officers  who  carried  this  plan  out 
which  deserves  credit  for  its  success. 

To  many  medical  men  this  treatment  will 
undoubtedly  seem  impracticable,  so  long 
has  it  been  the  custom  to  treat  this  disease 
merely  with  tilings  and  not  with  thoughts 
— merely  by  the  motion  of  the  hand,  but 
without  any  motion  of  the  brain — that  the 
matter  of  its  care  has  fallen  into  a  lazy 
reflex  act  performed  without  a  thought  of 
the  tragic  train  of  consequences  which  this 
kind  of  callous  treatment  brings  about. 

What  our  medical  friends  really  mean 
when  they  say  it  is  impracticable  is  that  it 
is  too  much  trouble ;  but  none  Avhose  minds 
are  capable  of  measuring  the  human  cost 
incident  to  gonococcus  infection  can  fail 
to  know  that  a  cure  of  this  disease  at  any 
cost    is    cheap.     So    many    doctors    cry: 


124  COXTROL  OF  SEX  INFECTIONS 

*^But  we  cannot  put  these  patients  to  bed! 
— They  must  keep  on  work! — Their  fami- 
lies would  know! — They  will  not  submit!'^ 
Oh,  great  physician,  where  has  your  author- 
ity gone?  Do  you  look  to  please  your  pa- 
tient or  to  cure  him  I  Are  you  looking  for 
his  dollars  or  his  deliverance?  If  you  are 
truly  working  for  your  patient's  interest 
you  will  spare  no  time  or  pains  in  show- 
ing him  the  truth  and  seeing  to  it  that  he 
goes  to  bed,  and  in  all  other  matters  fol- 
lows your  advice.  It  is  better  that  a  doc- 
tor goes  hungry  treating  three  patients  a 
day  properly  than  that  he  roll  around  in  a 
luxurious  motor  pleasing  thirty. 


CHAPTER  IX 
MAN^S  OBLIGATION  TO  SOCIETY 

Not  infrequently  is  the  statement  made 
by  an  individual  that  the  world  owes  him 
or  her  a  living.  When  put  by  anyone  in 
the  form  of  a  question,  the  answer  can  be 
unequivocally  in  the  affirmative ;  for  biolog- 
ically it  is  so,  the  world  does  indeed  owe 
all  its  creatures  a  living,  if  they  are  born 
with  the  vitality  to  gather  it  amidst  the 
hazards  of  the  process.  But  when  an  in- 
dividual means  that  society  owes  him  a  liv- 
ing, that  is  a  very  different  matter ;  for  so- 
ciety is  an  association,  or  if  you  choose  a 
club,  in  which  the  eligible  must  pay  their 
proportionate  way  in  good  manners,  fair 
dealing,  and  taxation  or  dues  to  defray  the 
necessary  expenses  incident  to  such  an  ad- 
vantageous membership. 

This  then  brings  us  by  a  very  direct  route 

125 


126  COXTEOL  OF  SEX  IKFECTIONS 

to  man's  obligation  to  society;  and  to  ad- 
venture into  this  field  for  a  few  moments 
may  not  be  without  advantage. 

If  this  is  so,  if  the  nation  can  be  called 
a  club  or  mutual  association,  and  states 
and  cities  and  so  on,  subdivisions  of  this 
mutual  benefit  idea,  and  really  not  an  arena 
for  riot,  a  field  for  fighting  one  another's 
endeavors,  a  place  of  political  plotting  for 
private  gains,  an  opportunity  to  profit  by 
oppressive  means;  then  we  gain  at  once  a 
very  good  notion  of  just  how  well  we  are 
managing  this  national  club  of  ours  today. 

A  well  run  club  with  an  acceptable  list 
of  by-laws  and  composed  of  carefully 
chosen  members  who  remain  in  good  stand- 
ing so  long  as  they  are  well  mannered, 
play  fair,  pay  their  dues  and  contribute 
their  share  to  the  upkeeping  of  their  insti- 
tution, goes  far  to  justify  its  existence  and 
set  a  standard  for  all  other  social  organi- 
zations. It  does  more ;  by  being  just  and 
by  sticking  to  its  rules  it  forms  a  habit  of 
good  order  and  understanding  which  robs 
its  members  of  dissatisfaction  or  distrust. 

Such  a  self-respecting  association  pro- 


MAN'S  OBLIGATION  TO  SOCIETY  127 

vides  a  very  good  example  to  keep  in  the 
mind  of  the  citizen  of  a  nation,  state  or 
smaller  community;  but  unhappily  a  very 
different  idea  has  come  to  take  the  place 
of  this  desirable  conception  of  human  so- 
ciety. So  different  an  idea  indeed  of  our 
social  organization  has  become  fixed  in  the 
minds  of  such  a  considerable  number  of 
its  members  that  no  thoughtful  person 
dares  to  put  these  ideas  down  to  mere  illu- 
sions. We  here  in  America  may  say  these 
unfortunate  results  of  our  well  intentioned 
beginnings  are  biological  reactions  and  can- 
not be  otherwise ;  but  it  is  too  easy  thus  to 
argue  out  our  present  state  of  psychic  ill- 
health,  or  evade  the  obligations  which  our 
former  neglect  or  lack  of  judgment  have 
entailed.  Starting  from,  or  rather  start- 
ing with,  our  declared  independence  as  a 
nation  which  was  set  up  in  the  midst  of  the 
greatest  plethora  of  natural  resources 
came  the  birth  of  a  mechanical  era  full  of 
the  greatest  promise  of  material  plenty. 
As  time  went  on,  in  order  to  haul  these 
riches  out  of  the  earth  or  from  the  field 
to  factory  or  foundry  and  from  thence  to 


128  CONTROL  OF  SEX  INFECTIONS 

distribute  them  it  required  a  great  human 
herd  of  helpers. 

At  this  point  in  our  eagerness  for  gam 
we  became  blind  to  the  first  requisite  of  a 
well  ordered  association  for  the  mutual 
benefit  of  all,  and  lowered  the  bars  to  mem- 
bership by  omitting  to  inquire  into  the 
qualifications  of  our  new  members,  in  fact 
we  did  not  want  them  as  members  at  all, 
but  so  eager  for  their  wage  work  were 
we  that  we  told  them  we  did,  and  that  they 
must  make  themselves  at  home  and  con- 
sider themselves  as  equals  in  our  club. 
Thus  was  the  first  rotten  beam  laid  in  the 
foundation  of  our  ^'free''  society.  With 
all  these  multiplying  multitudes  of  alien 
races  wresting  riches  out  of  the  ground  and 
in  the  factory  for  us,  a  great  opportunity 
of  political  ^^ progress"  became  possible — 
these  people  who  were  unfit  as  **club  mem- 
bers'' all  became  good  for  at  least  one  vote. 
Another  beam  in  our  national  structure. 

Any  active  minded  reader  can  continue 
this  process  of  ^  *  constructive  policy"  until 
he  has  our  present  ^^club"  house  fully 
completed,  and  looks  with  pride  upon  the 


MAN'S  OBLIGATION  TO  SOCIETY  129 

handicraft  and  art  entering  into  its  com- 
position. It  is  with  a  ^' close-up^'  here  and 
there  at  our  society  that  man  can  best  pro- 
portion out  what  his  obligations  in  that  di- 
rection are.  It  is  in  this  social  state  that 
the  roots  of  the  sexual  infections  find  such 
a  suitable  soil.  In  discussing  the  control 
of  these  evils  it  is  necessary  then  for  us 
to  acquaint  ourselves  with  the  sources  of 
their  nourishment. 

If  we  are  to  gain  control  of  these  degen- 
erating sexual  diseases  m^an^s  obligation  to 
society  must  show  itself  in  more  than  a 
passive  role.  In  this  period  of  social  re- 
construction it  will  be  necessary  to  build 
our  social  structures  up  from  a  firmer  base. 
Certain  fundamental  laws  of  nature  will 
needs  also  to  be  recognized.  The  idea  that 
we  can  repress  the  sexual  instinct  for  the 
purpose  of  more  profitably  pursuing  our 
industrial  and  commercial  aims,  will  need, 
along  with  a  number  of  other  ideas  as  to 
human  instinct  satisfactions,  a  profound 
remodelling. 

At  this  moment  of  opportunity  for  the 
masses  the  long  suppressed  instincts  of  this 


130  COXTROL  OF  SEX  INFECTIONS 

large  segment  of  society  are  showing  them- 
selves in  a  number  of  interesting  ways, 
which  bids  fair  to  undo,  and  perhaps  with 
violent  manifestations,  what  we  had  accus- 
tomed ourselves  to  term  as  either  progress 
or  profit. 

The  natural  pride  of  self-support,  of  self- 
respect,  of  good  workmanship  and  many 
other  traits  to  be  ascribed  as  normal,  have 
received  a  serious  set-back  as  shown  by  the 
present  stocktaking  of  an  over-industrial- 
ized era.  At  present  society  is  seriously 
sick.  The  war  may  be  looked  upon  as  a 
complicating  coincidence  of  the  disease. 
The  past  century  of  gorging, — of  mechani- 
cal feeding,  has  fouled  the  digestive  tract 
of  our  poor  social  body  while  it  has  left 
unused  or  shamefully  abused  other  vital 
functions  of  its  instinctive  life. 

All  this  points  plainly  enough  to  the 
need  of  a  better  general  social  health  be- 
fore the  ravaging  results  of  its  sexual  ills 
can  be  successfully  brought  to  bay. 

But  society  is  the  individual — the  social 
state  is  the  individual  state — so  that  if  we 


MAN'S  OBLIGATION  TO  SOCIETY  131 

are  going  to  obtain  real  results  in  the  es- 
sential riddance  of  these  infections — each 
one  must  have  some  clear  cut  impression 
of  his  or  her  part  in  the  matter. 

Thus,  those  for  example,  who  having 
read  through  the  chapters  of  this  small 
book,  fragmentary  and  incomplete  as  it  is, 
must  through  its  testimony  have  come  to 
a  larger  sense  of  their  personal  part  and 
their  unavoidable  obligation. 

One  cannot  view  with  quiet  unconcern 
the  war-made  records  of  these  diseases, 
and  knowing  what  is  inevitably  in  store  for 
the  children  of  the  next  generation,  quietly 
fold  the  hands  and  look  on  unmoved. 

No  normal  parents  who  have  come  to  a 
real  knowledge  of  the  costly  system  of  si- 
lence on  the  subject  of  sex  with  their  chil- 
dren can  easily  pursue  the  old  customs  of 
sham  in  the  future. 

Clergymen  and  all  other  ministers  and 
teachers  of  the  young  coming  to  realize 
the  enormous  amount  of  suffering  due  to 
their  default  of  this  subject  will  hardly  be 
satisfied  to  sit  on  in  silence. 


132  CONTROL  OF  SEX  INFECTIONS 

We  are  in  court,  on  trial  before  the 
children,  whose  lives  have  been  laid  waste 
by  these  sexual  infections. 

It  is  hard  to  imagine  any  excuse  which 
will  be  acceptable  for  this  neglect  of  man^s 
obligation  to  society. 


FEINTED  IN  THE  UNITED  STATES  OP  AMERICA 


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